Healthcare Provider Details

I. General information

NPI: 1245737642
Provider Name (Legal Business Name): AHSAN ZAKI NIAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR FL 10
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

PO BOX 746649
ATLANTA GA
30374-6649
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-5404
  • Fax: 904-391-5545
Mailing address:
  • Phone: 904-376-4400
  • Fax: 904-391-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME155422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: