| Doctor Name: | TARA PAVELEK |
| NPI Number: | 1679990493 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | P9438 |
| Business Practice Address: | 3601 Sw 160th Ave Suite 250 Miramar, FL - 330276308 |
| Business Phone Number: | 8778667123 |
| Business Fax Number: | 8558552792 |
| Mailing Address: | 1623 Main St, Apt 617 DALLAS |
| State: | TX |
| Postal Code: | 752014794 |
| Phone Number: | 8176765271 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2014 |
| NPI Last Update Date: | 05/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | P9438 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |