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NPI Code Detail

MEDICARE: DR. FIAZ AHMAD JALEEL M.D

MEDICARE: DR. FIAZ AHMAD JALEEL 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
1174400000XSpecialistME80212FL

General Provider Information

NPI Number : 1992896369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FIAZ AHMAD JALEEL M.D
Provider Business Mailing Address
First Line : 13500 SUTTON PARK DR S STE 202
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-5291
Country : US
Telephone Number : 904-744-7474
Fax Number : 904-786-9954
Provider Business Practice Location Address
First Line : 2725 REBECCA LN
Second Line : SUITE 107
City : ORANGE CITY
State : FL
Zip : 32763-8350
Country : US
Telephone Number : 386-775-0736
Fax Number : 386-775-0738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 09/25/2018

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