Healthcare Provider Details

I. General information

NPI: 1144244625
Provider Name (Legal Business Name): ZIA FATEMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 N SUN DR SUITE #104
LAKE MARY FL
32746-2599
US

IV. Provider business mailing address

758 N SUN DR SUITE #104
LAKE MARY FL
32746-2599
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-3303
  • Fax: 407-333-3342
Mailing address:
  • Phone: 407-333-3303
  • Fax: 407-333-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0074891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: