Healthcare Provider Details

I. General information

NPI: 1023109014
Provider Name (Legal Business Name): MIRZA SALEEM-UL ISLAM M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SALEEM ISLAM M.D., M.P.H.

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD #100119
GAINESVILLE FL
32610-0119
US

IV. Provider business mailing address

PO BOX 100119
GAINESVILLE FL
32610-0119
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-3718
  • Fax: 352-392-9081
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME98674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: