Healthcare Provider Details

I. General information

NPI: 1952732489
Provider Name (Legal Business Name): RIVERVIEW INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 07/06/2023
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13113 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

13113 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

V. Phone/Fax

Practice location:
  • Phone: 941-586-6989
  • Fax:
Mailing address:
  • Phone: 941-586-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 104484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME 104484
License Number StateFL

VIII. Authorized Official

Name: SALMAN AHMED
Title or Position: OWNER
Credential: MD
Phone: 941-586-6989