Provider Demographics
NPI:1235122953
Name:KAMAL, ASIF F (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:F
Last Name:KAMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21202 OLEAN BLVD.
Mailing Address - Street 2:UNIT C-1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-889-7440
Mailing Address - Fax:941-391-6089
Practice Address - Street 1:21202 OLEAN BLVD.
Practice Address - Street 2:UNIT C-1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-889-7440
Practice Address - Fax:941-391-6089
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007380241OtherAETNA
FL251051100Medicaid
FL32468OtherBCBS
FL0007380241OtherAETNA
FLG38507Medicare UPIN
DEHT488ZMedicare PIN