Basic Information
| Provider Information | |||||||||
| NPI: | 1669123287 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAM HOSPITALIST LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11310 LEMON LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328365070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077380803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13550 VILLAGE PARK DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328377835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077380803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2022 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | RIZVI | ||||||||
| AuthorizedOfficialFirstName: | ABBAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4077380803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QM2500X | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000000 | 01 | N/A | OTHER |