Provider Demographics
NPI:1033159819
Name:ATIQUZZAMAN, BASHER M (MD)
Entity Type:Individual
Prefix:
First Name:BASHER
Middle Name:M
Last Name:ATIQUZZAMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 N ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2308
Mailing Address - Country:US
Mailing Address - Phone:407-932-6193
Mailing Address - Fax:407-932-6194
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 302
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2308
Practice Address - Country:US
Practice Address - Phone:407-932-6193
Practice Address - Fax:407-932-6194
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME89652207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279595700Medicaid
FLP00392759OtherRR MEDICARE
H68378Medicare UPIN
FLP00392759OtherRR MEDICARE