Provider Demographics
NPI:1093297269
Name:PREMIER SPECIALISTS OF FLORIDA LLC
Entity Type:Organization
Organization Name:PREMIER SPECIALISTS OF FLORIDA LLC
Other - Org Name:PREMIER SPECIALISTS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVAID
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-440-3004
Mailing Address - Street 1:10179 RIDGEBLOOM AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7722
Mailing Address - Country:US
Mailing Address - Phone:407-440-3004
Mailing Address - Fax:407-429-3899
Practice Address - Street 1:7727 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:407-440-3004
Practice Address - Fax:407-429-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty