MEDICARE: EBRAHIM PAPAN M.D.

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	207R00000X	Internal Medicine Physician	ME0074844	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42701	OTHER	FL	FL BC

General Provider Information

NPI Number	:	1053318592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBRAHIM PAPAN M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 TAMIAMI TRL
Second Line	:	STE A
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3922
Country	:	US
Telephone Number	:	941-624-2704
Fax Number	:	941-627-6066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/16/2021

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