Basic Information
| Provider Information | |||||||||
| NPI: | 1346472446 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAMBER OF MEDICINE P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 327 W CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347413326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634191428 | ||||||||
| FaxNumber: | 8634221893 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 W CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074830672 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2009 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | IMTIAZ | ||||||||
| AuthorizedOfficialFirstName: | AZIZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROPREITER | ||||||||
| AuthorizedOfficialTelephone: | 8634191428 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | ME-100789 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.