Provider Demographics
NPI:1316939416
Name:BIRBECK, TAMMY L (DO)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:BIRBECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PINE ST STE 111A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4457
Mailing Address - Country:US
Mailing Address - Phone:941-681-2042
Mailing Address - Fax:941-208-5982
Practice Address - Street 1:900 PINE ST STE 111A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4457
Practice Address - Country:US
Practice Address - Phone:941-681-2042
Practice Address - Fax:941-208-5982
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011568207V00000X
MI5101013755207V00000X
FLOS10000207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10000OtherFLORIDA MEDICAL LICENSE
MI143446OtherGLHP
MI1656310015OtherBCBS OF MI
OH2667501Medicaid
MI7737491OtherAETNA
MI137116OtherCARE CHOICE
000000494798OtherANTHEM
FLJYT20OtherBCBS FL BLUE
MIP00254135OtherRRMC
FL1275072605OtherGROUP MEDICARE NPI
MI4786674Medicaid
MI04763OtherPARAMOUNT
MI33742OtherHPM
MI369742427-001OtherMMO
MI33742OtherHPM
MIM35150034Medicare PIN