Provider Demographics
NPI:1336311976
Name:SYED TARIQ MUMTAZ M D P A
Entity Type:Organization
Organization Name:SYED TARIQ MUMTAZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-944-4450
Mailing Address - Street 1:403 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4931
Mailing Address - Country:US
Mailing Address - Phone:407-944-4450
Mailing Address - Fax:407-944-1858
Practice Address - Street 1:403 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4931
Practice Address - Country:US
Practice Address - Phone:407-944-4450
Practice Address - Fax:407-944-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG32489Medicare UPIN
FLK8508Medicare PIN