Basic Information
| Provider Information | |||||||||
| NPI: | 1336311976 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SYED TARIQ MUMTAZ M D P A | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 403 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079444450 | ||||||||
| FaxNumber: | 4079441858 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079444450 | ||||||||
| FaxNumber: | 4079441858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MUMTAZ | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | TARIQ | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 4079444450 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME70936 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.