Healthcare Provider Details

I. General information

NPI: 1588002505
Provider Name (Legal Business Name): MOHAMMAD MASOOM QURESHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S DIXIE DR
HAINES CITY FL
33844-2801
US

IV. Provider business mailing address

8297 CHAMPIONS GATE BLVD # 463
CHAMPIONS GATE FL
33896-8387
US

V. Phone/Fax

Practice location:
  • Phone: 863-547-0788
  • Fax: 863-547-0789
Mailing address:
  • Phone: 863-547-0788
  • Fax: 863-547-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME126396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME126396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: