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General NPI Number Information
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NPI Number | 1033438759
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Entity Type | Organization
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Legal Business Name | M.ATIQ HESSAMI,M.D.,P.A.
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 33425 E LAKE JOANNA DR
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City | EUSTIS
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State | FL
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Zip | 32736-7249
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Country | US
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Telephone | 352-223-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 33425 E LAKE JOANNA DR
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City | EUSTIS
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State | FL
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Zip | 32736-7249
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Country | US
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Telephone | 352-223-5244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIRATIQULLAH HESSAMI
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Credential | M.D.
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Telephone | 352-223-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | P02000071278
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License Number State | FL
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