Basic Information
| Provider Information | |||||||||
| NPI: | 1720473051 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHSAN KAMAL MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 495009 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339495009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
| FaxNumber: | 9412763436 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MEDICAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342233964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
| FaxNumber: | 9412763436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | KAMAL | ||||||||
| AuthorizedOfficialFirstName: | AHSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9412065200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME97373 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.