Provider Demographics
NPI:1346620770
Name:HOSSAIN, MOHAMMED AMZAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:AMZAD
Last Name:HOSSAIN
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 1:110 E BERKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5620
Mailing Address - Country:US
Mailing Address - Phone:732-347-5584
Mailing Address - Fax:
Practice Address - Street 1:929 N US HIGHWAY 441 STE 503
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-578-2486
Practice Address - Fax:352-358-3884
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126913207R00000X, 207RN0300X
NY280758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine