Provider Demographics
NPI:1699785295
Name:THARP, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:THARP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1104 KYLE WOOD LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4850
Practice Address - Country:US
Practice Address - Phone:813-948-7550
Practice Address - Fax:813-948-7566
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-01-23
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Provider Licenses
StateLicense IDTaxonomies
FLME133157207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110164100Medicaid
B26944Medicare UPIN
IL0360906142Medicaid