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General NPI Number Information
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NPI Number | 1902282528
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Entity Type | Organization
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Legal Business Name | IGKHA LLC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 724 CHARLES ST
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City | ORLANDO
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State | FL
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Zip | 32808-7509
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Country | US
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Telephone | 407-295-2039
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Fax |
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Provider Business Mailing Address
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Address Line | 8980 KILGORE RD
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City | ORLANDO
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State | FL
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Zip | 32836-5414
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Country | US
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Telephone | 407-342-1896
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Fax | 407-876-8235
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Authorized Official
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Title or Position | PRESIDENT
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Name | GHAZALA I AHMED
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Credential | M.D.
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Telephone | 407-342-1896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0059456
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License Number State | FL
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