Individual provider Active NPI

Tannaz Nekoi-Panah, MD

  • Family Medicine Physician
  • Miami, FL
National Provider Identifier
1417576273
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME158252 Issued in FL
Practice address
3601 Federal Hwy
Miami, FL 33137-3795
Phone
(305) 576-6611
Fax
(786) 476-2832
NPI assigned
Apr 13, 2020
Last updated
Sep 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME158252 FL Primary

Addresses

Primary practice location

3601 Federal Hwy
Miami, FL 33137-3795

Mailing address

3601 Federal Hwy
Miami, FL 33137-3795
Phone (305) 576-6611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230808002442 FL Practitioner - Family Practice 0244692267 Reassigns benefits to 1 organization
I20240904004133 DC Practitioner - Family Practice 0244692267 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
CTD Network LLC CurrentSince Jul 31, 2023 Accepting new patients

Locations

1805 James L Redman Pkwy
#5412
Plant City, FL 33563

1805 James L Redman Pkwy
Ste 201
Plant City, FL 33563
Phone (305) 721-1101

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1417576273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 FEDERAL HWY",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331373795",
            "telephone_number": "305-576-6611",
            "fax_number": "786-476-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 FEDERAL HWY",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331373795",
            "telephone_number": "305-576-6611",
            "fax_number": "786-476-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEKOI-PANAH",
        "first_name": "TANNAZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-13",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME158252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.