Healthcare Provider Details

I. General information

NPI: 1346279460
Provider Name (Legal Business Name): BASIMA MUHAMMED ABDUL-RAZAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAZAK MD LLC

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803
US

IV. Provider business mailing address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax: 407-975-0413
Mailing address:
  • Phone: 407-975-0412
  • Fax: 407-975-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068389
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME134057
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU5052
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME134057
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC53991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: