Provider Demographics
NPI:1437222403
Name:MUNASIFI, FAISAL A (M D)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:A
Last Name:MUNASIFI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 M D LN STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5349
Mailing Address - Country:US
Mailing Address - Phone:850-877-0635
Mailing Address - Fax:850-205-0195
Practice Address - Street 1:1407 M D LN STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5349
Practice Address - Country:US
Practice Address - Phone:850-877-0635
Practice Address - Fax:850-205-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME297952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63304Medicare UPIN
FL95032Medicare ID - Type Unspecified