Healthcare Provider Details

I. General information

NPI: 1659968998
Provider Name (Legal Business Name): FLORIDA MED GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 5TH AVENUE NORTH
ST PETERSBURGH FL
33713-3371
US

IV. Provider business mailing address

PO BOX 7707
CLEARWATER FL
33758-7707
US

V. Phone/Fax

Practice location:
  • Phone: 727-466-3000
  • Fax: 727-844-5425
Mailing address:
  • Phone: 727-844-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD S HAYAT
Title or Position: MANAGER
Credential: MD
Phone: 727-466-3000