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General NPI Number Information
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NPI Number | 1346620770
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Entity Type | Individual
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Provider Name | MOHAMMED AMZAD HOSSAIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 929 N US HIGHWAY 441 STE 503
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-578-2486
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Fax | 352-358-3884
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Provider Business Mailing Address
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Address Line | 110 E BERKSHIRE CIR
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City | LONGWOOD
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State | FL
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Zip | 32779-5620
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Country | US
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Telephone | 732-347-5584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME126913
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 280758
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME126913
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License Number State | FL
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