Healthcare Provider Details

I. General information

NPI: 1346288768
Provider Name (Legal Business Name): AWAIS K HUMAYUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AWAIS KITTU HUMAYUN MD

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/07/2023
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 104
DAVIE FL
33328-3835
US

IV. Provider business mailing address

4801 S UNIVERSITY DR STE 104
DAVIE FL
33328-3835
US

V. Phone/Fax

Practice location:
  • Phone: 954-707-5200
  • Fax: 954-526-4562
Mailing address:
  • Phone: 954-707-5200
  • Fax: 954-526-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME78681
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME78681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: