Basic Information
| Provider Information | |||||||||
| NPI: | 1649820267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA ADVANCED PRIMARY, URGENT & HOLISTIC MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2522 OAK RUN BLVD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347443017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077380803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8931 HERITAGE BAY CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328365026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077380803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | RIZVI | ||||||||
| AuthorizedOfficialFirstName: | ABBAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4077380803 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.