Healthcare Provider Details

I. General information

NPI: 1851904601
Provider Name (Legal Business Name): MOBASHIR HOSAMEDDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7500
  • Fax: 305-558-8679
Mailing address:
  • Phone: 305-558-2500
  • Fax: 305-558-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME163750
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME163750
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number90235
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: