Basic Information
| Provider Information | |||||||||
| NPI: | 1386268993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA ADVANCED MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13550 VILLAGE PARK DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328377835 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 8333982081 | ||||||||
| Practice Location | |||||||||
| Address1: | 13550 VILLAGE PARK DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328377835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077380803 | ||||||||
| FaxNumber: | 8333982081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2020 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | RIZVI | ||||||||
| AuthorizedOfficialFirstName: | ABBAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4077380803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.