Healthcare Provider Details

I. General information

NPI: 1487214888
Provider Name (Legal Business Name): BISMA GOWANI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 STIRLING RD STE 108
HOLLYWOOD FL
33024-8001
US

IV. Provider business mailing address

8721 LAKE TIBET CT
ORLANDO FL
32836-5481
US

V. Phone/Fax

Practice location:
  • Phone: 407-463-8621
  • Fax:
Mailing address:
  • Phone: 407-463-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberE5991
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE5991
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: