Healthcare Provider Details

I. General information

NPI: 1033159819
Provider Name (Legal Business Name): BASHER M ATIQUZZAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ORANGE BLOSSOM TRAIL SUITE 302
KISSIMMEE FL
34744-2308
US

IV. Provider business mailing address

2400 N ORANGE BLOSSOM TRAIL SUITE 302
KISSIMMEE FL
34744-2308
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-6193
  • Fax: 407-932-6194
Mailing address:
  • Phone: 407-932-6193
  • Fax: 407-932-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME89652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: