Basic Information
| Provider Information | |||||||||
| NPI: | 1467569533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASHI | ||||||||
| FirstName: | MARYAM | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073031812 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073031812 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L6974 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | OS10919 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | OS10919 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002135700 | 05 | FL | MEDICAID | 149N9 | 01 | FL | BCBS | OTHER | 161470302 | 05 | TX | MEDICAID |