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General NPI Number Information
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NPI Number | 1851560478
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Entity Type | Organization
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Legal Business Name | METROLINA INFECTIOUS DISEASES, P.A.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 219 PALERMO PL
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City | VENICE
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State | FL
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Zip | 34285-2821
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Country | US
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Telephone | 941-244-9524
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Fax | 941-244-9526
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Provider Business Mailing Address
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Address Line | 219 PALERMO PL
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City | VENICE
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State | FL
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Zip | 34285-2821
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Country | US
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Telephone | 941-244-9524
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Fax | 941-244-9526
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. AHMED OMER FAROOQ
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Credential |
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Telephone | 980-328-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2005-00638
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License Number State | NC
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