Healthcare Provider Details

I. General information

NPI: 1992708168
Provider Name (Legal Business Name): MUBEEN HASAN CHIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MANGOUSTINE AVE STE 200
SANFORD FL
32771-1004
US

IV. Provider business mailing address

305 N MANGOUSTINE AVE STE 200
SANFORD FL
32771-1004
US

V. Phone/Fax

Practice location:
  • Phone: 407-321-1415
  • Fax: 407-321-1597
Mailing address:
  • Phone: 407-321-1415
  • Fax: 407-321-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0062681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: