Basic Information
| Provider Information | |||||||||
| NPI: | 1083878656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAEB | ||||||||
| FirstName: | PARISIMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153715744 | ||||||||
| FaxNumber: | 8882411404 | ||||||||
| Practice Location | |||||||||
| Address1: | 2776 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339015864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393432837 | ||||||||
| FaxNumber: | 2393433164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 01066717A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MT189463 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME106617 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | ME106617 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000640373 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER | 200974170 | 05 | IN | MEDICAID |