Provider Demographics
NPI:1083915136
Name:HUSAIN F NAGAMIA MD PA
Entity Type:Organization
Organization Name:HUSAIN F NAGAMIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSAIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:NAGAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-654-4466
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:SUITE 203 EAST TOWER
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-654-4466
Mailing Address - Fax:813-684-5500
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 203 EAST TOWER
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-654-4466
Practice Address - Fax:813-684-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058269700Medicaid
FLB72970Medicare UPIN
FL29978Medicare PIN