Basic Information
| Provider Information | |||||||||
| NPI: | 1588612337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFEEZ | ||||||||
| FirstName: | JAVED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3909 GALEN CT | ||||||||
| Address2: | SUITE #102 | ||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335736817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136345502 | ||||||||
| FaxNumber: | 8136332702 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 GALEN CT | ||||||||
| Address2: | SUITE #102 | ||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335736817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136345502 | ||||||||
| FaxNumber: | 8136332702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME045647 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110022440 | 01 | FL | PALMETTO GBA-RAILROAD MEDICARE | OTHER | 3968482 | 01 | FL | CIGNA | OTHER | 046403100 | 05 | FL | MEDICAID | 04167 | 01 | FL | BLUE CROSS/BLUE SHIELD OF FLORIDA | OTHER | 0406027 | 01 | FL | UNITED HEALTHCARE/EVERCARE | OTHER |