Individual
TAMIM ANTAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, SUITE 102, MELBOURNE, FL 32901-3224
(321) 434-3455
(321) 434-3456
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3455
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME128056
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017282900
—
FL
01
—
IP030Z
MEDICARE
FL
Enumeration date
10/13/2006
Last updated
05/01/2018
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