Provider Demographics
NPI:1083882328
Name:AMIR FAHMY MD PA
Entity Type:Organization
Organization Name:AMIR FAHMY MD PA
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-622-7604
Mailing Address - Street 1:3345 BURNS RD
Mailing Address - Street 2:STE#204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4324
Mailing Address - Country:US
Mailing Address - Phone:561-622-7604
Mailing Address - Fax:561-622-7542
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:STE#204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:561-622-7604
Practice Address - Fax:561-622-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912998436OtherINDIVIDUAL NPI
FL265237400Medicaid
FLK0056Medicare PIN
FLG85607Medicare UPIN