Healthcare Provider Details

I. General information

NPI: 1750752614
Provider Name (Legal Business Name): KAMRAN AZAD, MD P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 S ORLANDO AVE STE 100
WINTER PARK FL
32789-4849
US

IV. Provider business mailing address

8469 NEMOURS PKWY
ORLANDO FL
32827-7753
US

V. Phone/Fax

Practice location:
  • Phone: 407-848-3400
  • Fax: 407-602-0901
Mailing address:
  • Phone: 914-806-0653
  • Fax: 407-602-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number128991
License Number StateCA

VIII. Authorized Official

Name: DR. KAMRAN AZAD
Title or Position: PLASTIC SURGEON
Credential: MD
Phone: 914-806-0653