Healthcare Provider Details

I. General information

NPI: 1619947652
Provider Name (Legal Business Name): KAMAL ANJUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 HOLLYWOOD BLVD
HOLLYWOOD FL
33024-7969
US

IV. Provider business mailing address

PO BOX 1193
HALLANDALE FL
33008-1193
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-0974
  • Fax: 954-589-0975
Mailing address:
  • Phone: 305-332-9977
  • Fax: 954-589-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME80940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: