Provider Demographics
NPI:1023020500
Name:MUMTAZ, HAMID (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:MUMTAZ
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 1:2700 HEALING WAY STE 310
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5453
Mailing Address - Country:US
Mailing Address - Phone:813-779-1209
Mailing Address - Fax:813-779-1216
Practice Address - Street 1:2700 HEALING WAY STE 310
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-779-1209
Practice Address - Fax:813-779-1216
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138715208G00000X
ARE-3401208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP01149504OtherRAILROAD MCARE
AR154513001Medicaid
AR154513001Medicaid
AR5M974Medicare ID - Type Unspecified
ARP01149504OtherRAILROAD MCARE
5M974Medicare PIN