Healthcare Provider Details

I. General information

NPI: 1831325588
Provider Name (Legal Business Name): NASEEM B LATIF, MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 LEE RD
WINTER PARK FL
32789-1750
US

IV. Provider business mailing address

2306 LEE RD
WINTER PARK FL
32789-1750
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-0705
  • Fax: 407-629-5285
Mailing address:
  • Phone: 407-629-0705
  • Fax: 407-629-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0031828
License Number StateFL

VIII. Authorized Official

Name: NASEEM BANO LATIF
Title or Position: OWNER/ DOCTOR
Credential: M.D.
Phone: 407-629-0705