Healthcare Provider Details

I. General information

NPI: 1326031931
Provider Name (Legal Business Name): MUHAMMED Y MEMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 TAMIAMI TRL STE 5
PORT CHARLOTTE FL
33952
US

IV. Provider business mailing address

2852 TAMIAMI TRL STE 5
PORT CHARLOTTE FL
33952-5100
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-9494
  • Fax: 941-743-8562
Mailing address:
  • Phone: 941-625-9494
  • Fax: 941-743-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0022458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: