Healthcare Provider Details

I. General information

NPI: 1548083462
Provider Name (Legal Business Name): AYMAN ABDULAZIZ M MUKHTAR MBBS, DABIM, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 877-876-3627
  • Fax: 321-841-3794
Mailing address:
  • Phone: 877-876-3627
  • Fax: 321-841-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME171148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: