Healthcare Provider Details

I. General information

NPI: 1548337934
Provider Name (Legal Business Name): NIZAM RAZACK, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W GORE ST SUITE 511
ORLANDO FL
32806-1114
US

IV. Provider business mailing address

32 W GORE ST SUITE 511
ORLANDO FL
32806-1114
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-7172
  • Fax: 407-423-9505
Mailing address:
  • Phone: 407-423-7172
  • Fax: 407-423-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIZAM RAZACK
Title or Position: OWNER
Credential: MD
Phone: 407-423-7172