MEDICARE: FAMILY PRACTICE OF CENTRAL FL, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1346440617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE OF CENTRAL FL, P.A.

Provider Business Mailing Address
First Line	:	1349 S INTERNATIONAL PKWY
Second Line	:	SUITE 1411
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1697
Country	:	US
Telephone Number	:	407-333-3360
Fax Number	:	407-333-2920

Provider Business Practice Location Address
First Line	:	1349 S INTERNATIONAL PKWY
Second Line	:	SUITE 1411
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1697
Country	:	US
Telephone Number	:	407-333-3360
Fax Number	:	407-333-2920

Authorized Official
Title or Position	:	OWNER
Name	:	AYESHA AHMAR
Credential	:	M.D.
Telephone Number	:	407-333-3360

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	11/27/2007

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