MEDICARE: BASSAM AMAWI 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	2084P0800X	Psychiatry Physician	ME50613	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134143233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASSAM AMAWI M.D.

Provider Business Mailing Address
First Line	:	450 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5187
Country	:	US
Telephone Number	:	386-299-3393
Fax Number	:	386-257-2119

Provider Business Practice Location Address
First Line	:	450 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5187
Country	:	US
Telephone Number	:	386-299-3393
Fax Number	:	386-257-2119

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/28/2011

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Directions to “ BASSAM AMAWI M.D.” Practice Location

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