Provider Demographics
NPI:1346472446
Name:CHAMBER OF MEDICINE P.A.
Entity Type:Organization
Organization Name:CHAMBER OF MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPREITER
Authorized Official - Prefix:
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:IMTIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-419-1428
Mailing Address - Street 1:327 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3326
Mailing Address - Country:US
Mailing Address - Phone:863-419-1428
Mailing Address - Fax:863-422-1893
Practice Address - Street 1:327 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-483-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-22
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-100789261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care