Provider Demographics
NPI:1447237045
Name:RAZACK, NIZAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NIZAM
Middle Name:
Last Name:RAZACK
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 1:7460 DOCS GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8010
Mailing Address - Country:US
Mailing Address - Phone:407-423-7172
Mailing Address - Fax:407-423-9505
Practice Address - Street 1:32 W GORE ST
Practice Address - Street 2:SUITE #511
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1134
Practice Address - Country:US
Practice Address - Phone:407-423-7172
Practice Address - Fax:407-423-9505
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70470207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254681700Medicaid
FL43363WMedicare PIN
FL254681700Medicaid