MEDICARE: MOHAMMAD ALI FAISAL, M.D., P.A.

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	174400000X	Specialist	ME58587	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21142	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689639353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMMAD ALI FAISAL, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 3009
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-3009
Country	:	US
Telephone Number	:	386-758-5985
Fax Number	:	386-758-5987

Provider Business Practice Location Address
First Line	:	1283 SW STATE ROAD 47
Second Line	:	SUITE 104
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0490
Country	:	US
Telephone Number	:	386-758-5985
Fax Number	:	386-758-5987

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMAD ALI FAISAL
Credential	:	M.D.
Telephone Number	:	386-758-5985

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	05/19/2014

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