Provider Demographics
NPI:1083881239
Name:GASTROENTEROLOGY AND LIVER DISEASES OF CENTRAL FLORIDA PA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND LIVER DISEASES OF CENTRAL FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-399-1311
Mailing Address - Street 1:PO BOX 950177
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-0177
Mailing Address - Country:US
Mailing Address - Phone:386-218-6893
Mailing Address - Fax:386-218-6895
Practice Address - Street 1:2541 S VOLUSIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9116
Practice Address - Country:US
Practice Address - Phone:386-218-6893
Practice Address - Fax:386-218-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90434207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18165Medicare UPIN