Healthcare Provider Details

I. General information

NPI: 1982681185
Provider Name (Legal Business Name): MARIAM ADAM ESAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 CYPRESS GLEN CIRCLE
KISSIMMEE FL
34741-4989
US

IV. Provider business mailing address

4156 BROOKMYRA DR
ORLANDO FL
32837-5109
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-5917
  • Fax: 407-350-5928
Mailing address:
  • Phone: 407-350-5917
  • Fax: 407-350-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME88164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: