Healthcare Provider Details

I. General information

NPI: 1003801044
Provider Name (Legal Business Name): FIAZ MD AFZAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MANN ST TELADOC HEALTH SOLUTIONS LLC
KISSIMMEE FL
34741-4121
US

IV. Provider business mailing address

1000 MANN ST TELADOC HEALTH SOLUTIONS LLC
KISSIMMEE FL
34741-4121
US

V. Phone/Fax

Practice location:
  • Phone: 647-773-9028
  • Fax: 407-785-3234
Mailing address:
  • Phone: 647-773-9028
  • Fax: 407-785-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA06493600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06493600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: