Healthcare Provider Details

I. General information

NPI: 1154981603
Provider Name (Legal Business Name): GANDIH GHEIR IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 S HIGHWAY 25
WEIRSDALE FL
32195-2442
US

IV. Provider business mailing address

16400 S HIGHWAY 25
WEIRSDALE FL
32195-2442
US

V. Phone/Fax

Practice location:
  • Phone: 352-821-9797
  • Fax: 352-821-0553
Mailing address:
  • Phone: 352-821-9797
  • Fax: 352-821-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME153317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: