Provider Demographics
NPI:1326196908
Name:MID FLORIDA KIDNEY AND HYPERTENSION CARE PL
Entity Type:Organization
Organization Name:MID FLORIDA KIDNEY AND HYPERTENSION CARE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-265-2540
Mailing Address - Street 1:631 PALM SPRINGS DR
Mailing Address - Street 2:STE 104
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7854
Mailing Address - Country:US
Mailing Address - Phone:407-265-2540
Mailing Address - Fax:407-265-9167
Practice Address - Street 1:631 PALM SPRINGS DR
Practice Address - Street 2:STE 104
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-265-2540
Practice Address - Fax:407-265-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH39632Medicare UPIN
FLK9523Medicare PIN