MEDICARE: WAQAS A GHUMMAN 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	204F00000X	Transplant Surgery Physician	01052070A	IN
2	207RC0000X	Cardiovascular Disease Physician	01052070A	IN
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	01052070A	IN
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01052070A	IN
5	2086S0129X	Vascular Surgery Physician	01052070A	IN
6	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	ME126314	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01214639	OTHER	IN	RR MEDICARE PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619931516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAQAS A GHUMMAN M.D.

Provider Business Mailing Address
First Line	:	180 JFK DR
Second Line	:	SUITE 320
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6641
Country	:	US
Telephone Number	:	561-548-4900
Fax Number	:	561-434-5165

Provider Business Practice Location Address
First Line	:	180 JFK DR
Second Line	:	SUITE 320
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6641
Country	:	US
Telephone Number	:	561-548-4900
Fax Number	:	561-434-5165

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/10/2022

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Directions to “ WAQAS A GHUMMAN M.D.” Practice Location

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