Provider Demographics
NPI:1033195839
Name:AFZAL, FUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FUAD
Middle Name:
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:PO BOX 952951
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-2951
Mailing Address - Country:US
Mailing Address - Phone:407-265-2540
Mailing Address - Fax:407-265-9167
Practice Address - Street 1:631 PALM SPRINGS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-265-2540
Practice Address - Fax:407-265-9167
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94056207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39632Medicare UPIN