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General NPI Number Information
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NPI Number | 1770522112
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Entity Type | Individual
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Provider Name | EBRAHIM HOOSIEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD SUITE 211, MEDICAL MALL 2
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-422-0082
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Fax | 561-422-0083
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Provider Business Mailing Address
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Address Line | 13005 SOUTHERN BLVD SUITE 211,
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9272
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Country | US
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Telephone | 561-422-0082
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Fax | 561-422-0083
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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 | ME86884
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License Number State | FL
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