Provider Demographics
NPI:1043512908
Name:KAYUM MOHAMMADBHOY, M.D.,P.L.
Entity Type:Organization
Organization Name:KAYUM MOHAMMADBHOY, M.D.,P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAYUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADBHOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-993-5056
Mailing Address - Street 1:3114 SE MONTGOMERY CIR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3127
Mailing Address - Country:US
Mailing Address - Phone:863-993-5920
Mailing Address - Fax:863-773-5056
Practice Address - Street 1:250 N BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4406
Practice Address - Country:US
Practice Address - Phone:863-993-5920
Practice Address - Fax:863-773-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019370207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050532300Medicaid
FL050532300Medicaid
FLD85092Medicare UPIN