=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043512908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAYUM MOHAMMADBHOY, M.D.,P.L.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2010
-----------------------------------------------------
Last Update Date | 11/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 N BREVARD AVE
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-4406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-993-5920
-----------------------------------------------------
Fax | 863-773-5056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3114 SE MONTGOMERY CIR
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-3127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-993-5920
-----------------------------------------------------
Fax | 863-773-5056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | KAYUM MOHAMMADBHOY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 863-993-5056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME0019370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------