Healthcare Provider Details

I. General information

NPI: 1902844699
Provider Name (Legal Business Name): IRFAN RIAZ IMAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-549-0815
  • Fax: 407-650-1307
Mailing address:
  • Phone: 321-549-0815
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME91536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: