Provider Demographics
NPI:1437268620
Name:MOOSA, MOHAMMED AK (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:AK
Last Name:MOOSA
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 1:2869 WILSHIRE DR
Mailing Address - Street 2:STE 205
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3282
Mailing Address - Country:US
Mailing Address - Phone:407-295-0500
Mailing Address - Fax:407-290-2997
Practice Address - Street 1:2869 WILSHIRE DR
Practice Address - Street 2:STE 205
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3282
Practice Address - Country:US
Practice Address - Phone:407-295-0500
Practice Address - Fax:407-290-2997
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001683200Medicaid
FL145EKOtherBCBS ID
FLBX272XMedicare PIN
FL145EKOtherBCBS ID