Healthcare Provider Details

I. General information

NPI: 1609220672
Provider Name (Legal Business Name): BABAK MEDHAT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7403
US

IV. Provider business mailing address

13800 VETERANS WAY
ORLANDO FL
32827-7403
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT14975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: