Basic Information
| Provider Information | |||||||||
| NPI: | 1619931516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHUMMAN | ||||||||
| FirstName: | WAQAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 JFK DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5614345165 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 JFK DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5614345165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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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 | 204F00000X | 01052070A | IN | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 207RC0000X | 01052070A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 01052070A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0200X | 01052070A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 2086S0129X | 01052070A | IN | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 207RA0001X | ME126314 | FL | Y |
ID Information
| ID | Type | State | Issuer | Description | 200375660 | 05 | IN | MEDICAID | P01214639 | 01 | IN | RR MEDICARE PTAN | OTHER |