Provider Demographics
NPI:1144244625
Name:FATEMI, ZIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIA
Middle Name:
Last Name:FATEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 N SUN DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2599
Mailing Address - Country:US
Mailing Address - Phone:407-333-3303
Mailing Address - Fax:407-333-3342
Practice Address - Street 1:758 N SUN DR
Practice Address - Street 2:SUITE #104
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2599
Practice Address - Country:US
Practice Address - Phone:407-333-3303
Practice Address - Fax:407-333-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43528XMedicare ID - Type UnspecifiedMEDICARE
FLG00021Medicare UPIN