Healthcare Provider Details

I. General information

NPI: 1538619952
Provider Name (Legal Business Name): WINTER PARK FAMILY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 CANTON CV SUITE 121
WINTER SPRINGS FL
32708-5012
US

IV. Provider business mailing address

P.O. BOX 180898
CASSELBERRY FL
32718-0898
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2550
  • Fax: 407-647-0616
Mailing address:
  • Phone: 407-647-2550
  • Fax: 407-647-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME92346
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME112530
License Number StateFL

VIII. Authorized Official

Name: AHMAD B AMAWI
Title or Position: PRESIDENT
Credential: MD
Phone: 407-647-2550