=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922093079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA PULMONARY CONSULTANTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1788 W FAIRBANKS AVE STE A
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-4681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-740-5447
-----------------------------------------------------
Fax | 407-740-5532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1788 W FAIRBANKS AVE STE A
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-4681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-740-5447
-----------------------------------------------------
Fax | 407-740-5532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FAISAL A FAKIH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-740-5447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0034351
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------