Provider Demographics
NPI:1003801044
Name:AFZAL, FIAZ MD (MD)
Entity Type:Individual
Prefix:DR
First Name:FIAZ
Middle Name:MD
Last Name:AFZAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MANN ST
Mailing Address - Street 2:TELADOC HEALTH SOLUTIONS LLC
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4121
Mailing Address - Country:US
Mailing Address - Phone:647-773-9028
Mailing Address - Fax:407-785-3234
Practice Address - Street 1:1000 MANN ST
Practice Address - Street 2:TELADOC HEALTH SOLUTIONS LLC
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4121
Practice Address - Country:US
Practice Address - Phone:647-773-9028
Practice Address - Fax:407-785-3234
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06493600207QA0505X, 207R00000X
LA11980R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1687553Medicaid
LA5Y211Medicare ID - Type Unspecified
LA1687553Medicaid