MEDICARE: DR. MOHAMMAD MASOOM QURESHI M.D.

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	ME126396	FL
2	2084N0400X	Neurology Physician	ME126396	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588002505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD MASOOM QURESHI M.D.

Provider Business Mailing Address
First Line	:	8297 CHAMPIONS GATE BLVD # 463
Second Line	:
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8387
Country	:	US
Telephone Number	:	863-547-0788
Fax Number	:	863-547-0789

Provider Business Practice Location Address
First Line	:	212 S DIXIE DR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-2801
Country	:	US
Telephone Number	:	863-547-0788
Fax Number	:	863-547-0789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	01/19/2024

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Directions to “ DR. MOHAMMAD MASOOM QURESHI M.D.” Practice Location

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