MEDICARE: M.ATIQ HESSAMI,M.D.,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	P02000071278	FL

General Provider Information

NPI Number	:	1033438759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.ATIQ HESSAMI,M.D.,P.A.

Provider Business Mailing Address
First Line	:	33425 E LAKE JOANNA DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-7249
Country	:	US
Telephone Number	:	352-223-5244
Fax Number	:

Provider Business Practice Location Address
First Line	:	33425 E LAKE JOANNA DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-7249
Country	:	US
Telephone Number	:	352-223-5244
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIRATIQULLAH HESSAMI
Credential	:	M.D.
Telephone Number	:	352-223-5244

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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