MEDICARE: IMAD RAZVI MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1427558626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAD RAZVI MD LLC

Provider Business Mailing Address
First Line	:	10144 ARBOR RUN DR UNIT 8
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10144 ARBOR RUN DR UNIT 8
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3568
Country	:	US
Telephone Number	:	813-995-0984
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IMADUDDIN RAZVI
Credential	:	MD
Telephone Number	:	813-997-2099

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	02/15/2018

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