Healthcare Provider Details

I. General information

NPI: 1972006781
Provider Name (Legal Business Name): MOHAMMAD ABUALGANAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 TURKEY LAKE RD
ORLANDO FL
32819-8001
US

IV. Provider business mailing address

9400 TURKEY LAKE RD
ORLANDO FL
32819-8001
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8505
  • Fax: 321-843-8550
Mailing address:
  • Phone: 321-842-8505
  • Fax: 321-843-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME155799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: