Healthcare Provider Details

I. General information

NPI: 1023453222
Provider Name (Legal Business Name): BEGUM INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 SW STATE ROAD 47 SUITE 101
LAKE CITY FL
32025-0489
US

IV. Provider business mailing address

1283 SW STATE ROAD 47 SUITE 101
LAKE CITY FL
32025-0489
US

V. Phone/Fax

Practice location:
  • Phone: 386-438-5255
  • Fax: 386-438-5618
Mailing address:
  • Phone: 386-438-5255
  • Fax: 386-438-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME109244
License Number StateFL

VIII. Authorized Official

Name: DR. TOHMINA BEGUM
Title or Position: OWNER
Credential: MD
Phone: 203-695-3966