Provider Demographics
NPI:1194375378
Name:DIGESTIVE AND LIVER DISEASE INSTITUTE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:DIGESTIVE AND LIVER DISEASE INSTITUTE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIQUZZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-415-2481
Mailing Address - Street 1:505 W OAK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4986
Mailing Address - Country:US
Mailing Address - Phone:407-846-6331
Mailing Address - Fax:407-846-0137
Practice Address - Street 1:505 W OAK ST STE 202
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4986
Practice Address - Country:US
Practice Address - Phone:407-846-6331
Practice Address - Fax:407-846-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty