Basic Information
| Provider Information | |||||||||
| NPI: | 1861428260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUKAYED | ||||||||
| FirstName: | USAMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6006 49TH ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
| FaxNumber: | 8443055954 | ||||||||
| Practice Location | |||||||||
| Address1: | 6006 49TH ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
| FaxNumber: | 8443055954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | ME0051285 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | ME0051285 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 010022920 | 01 | RAILROAD MEDICARE PIN | OTHER | 061768700 | 05 | FL | MEDICAID |