Basic Information
| Provider Information | |||||||||
| NPI: | 1134534050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARIS | ||||||||
| FirstName: | AHMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 KUHL AVE # MP38 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218424713 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9400 TURKEY LAKE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328198001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218428505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME153189 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 94-08711 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | NE153189 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.