Healthcare Provider Details

I. General information

NPI: 1376275719
Provider Name (Legal Business Name): FAIZAN ASHARAF BHAI MASTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13311 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

26854 SAXONY WAY APT 201
WESLEY CHAPEL FL
33544-6485
US

V. Phone/Fax

Practice location:
  • Phone: 813-899-2015
  • Fax: 813-355-5904
Mailing address:
  • Phone: 682-352-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME174635
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125081015
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036172592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: