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General NPI Number Information
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NPI Number | 1942470620
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Entity Type | Organization
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Legal Business Name | FAMILY & INTERNAL MEDICINE CENTER PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 11183 S ORANGE BLOSSOM TRL SUITE A
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City | ORLANDO
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State | FL
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Zip | 32837-9402
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Country | US
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Telephone | 407-859-8686
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Fax | 407-859-7171
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Provider Business Mailing Address
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Address Line | 11183 S ORANGE BLOSSOM TRL SUITE A
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City | ORLANDO
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State | FL
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Zip | 32837-9402
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Country | US
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Telephone | 407-859-8686
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Fax | 407-859-7171
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAHIRA H QURESHI
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Credential | MD. ARNP
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Telephone | 407-859-8686
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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 | ME0077164
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License Number State | FL
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