=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871558023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZAKIUDDIN AHMED MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7420 COMMUNITY CT
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-8216
-----------------------------------------------------
Fax | 727-869-8122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7420 COMMUNITY CT
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-8216
-----------------------------------------------------
Fax | 727-869-8122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZAKIUDDIN AHMED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-869-8216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 80528
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------