MEDICARE: GASTROENTEROLOGY AND LIVER DISEASES OF CENTRAL FLORIDA PA

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	207RI0008X	Hepatology Physician	ME90434	FL
2	207RG0100X	Gastroenterology Physician	ME90434	FL

General Provider Information

NPI Number	:	1083881239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY AND LIVER DISEASES OF CENTRAL FLORIDA PA

Provider Business Mailing Address
First Line	:	PO BOX 950177
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32795-0177
Country	:	US
Telephone Number	:	386-218-6893
Fax Number	:	386-218-6895

Provider Business Practice Location Address
First Line	:	2541 S VOLUSIA AVE STE 300
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9116
Country	:	US
Telephone Number	:	386-218-6893
Fax Number	:	386-218-6895

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAAD M KHAN
Credential	:	MD
Telephone Number	:	407-399-1311

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/17/2012

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