Provider Demographics
NPI:1326031931
Name:MEMON, MUHAMMED Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMED
Middle Name:Y
Last Name:MEMON
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 1:2852 TAMIAMI TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5100
Mailing Address - Country:US
Mailing Address - Phone:941-625-9494
Mailing Address - Fax:941-743-8562
Practice Address - Street 1:2852 TAMIAMI TRL STE 5
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-625-9494
Practice Address - Fax:941-743-8562
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022458207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08109OtherBCBS
FLD47750Medicare UPIN
FL08109OtherBCBS
FL140000038Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL08109Medicare ID - Type Unspecified