=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326196908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID FLORIDA KIDNEY AND HYPERTENSION CARE PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 631 PALM SPRINGS DR STE 104
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-7854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-265-2540
-----------------------------------------------------
Fax | 407-265-2540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 631 PALM SPRINGS DR STE 104
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-7854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-265-2540
-----------------------------------------------------
Fax | 407-265-9167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. FUAD AFZAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-265-2540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME94056
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------