Provider Demographics
NPI:1699713214
Name:TANE, KLITI (MD)
Entity type:Individual
Prefix:DR
First Name:KLITI
Middle Name:
Last Name:TANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 SAWGRS CORP PKWY
Mailing Address - Street 2:SUITE110
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2828
Mailing Address - Country:US
Mailing Address - Phone:954-835-0865
Mailing Address - Fax:
Practice Address - Street 1:1551 SAWGRS CORP PKWY
Practice Address - Street 2:SUITE110
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2828
Practice Address - Country:US
Practice Address - Phone:954-835-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685523Medicaid
NY330AB1Medicare ID - Type Unspecified