Provider Demographics
NPI:1245562677
Name:MUHAMMED Y MEMON MD PA
Entity Type:Organization
Organization Name:MUHAMMED Y MEMON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-0414
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5052
Mailing Address - Country:US
Mailing Address - Phone:941-625-0414
Mailing Address - Fax:941-625-5984
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:STE 10
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-625-0414
Practice Address - Fax:941-625-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022458207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCW901AMedicare PIN