Healthcare Provider Details

I. General information

NPI: 1982802823
Provider Name (Legal Business Name): FAROOQ LATEEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 TURKEY LAKE RD SUITE 110
ORLANDO FL
32819-4200
US

IV. Provider business mailing address

2810 W SAINT ISABEL ST STE 201
TAMPA FL
33607-6375
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-1888
  • Fax: 407-226-9804
Mailing address:
  • Phone: 813-890-8004
  • Fax: 813-290-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number75932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: