Healthcare Provider Details

I. General information

NPI: 1356572119
Provider Name (Legal Business Name): FAIZI AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE STE 203
TAMPA FL
33614-7146
US

IV. Provider business mailing address

603 S BOULEVARD FL 2
TAMPA FL
33606-2629
US

V. Phone/Fax

Practice location:
  • Phone: 813-995-1775
  • Fax: 813-642-4877
Mailing address:
  • Phone: 940-447-1601
  • Fax: 813-642-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberFA3851094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: