Provider Demographics
NPI:1477502557
Name:ALAM, AMBREEN SYED (DO)
Entity Type:Individual
Prefix:
First Name:AMBREEN
Middle Name:SYED
Last Name:ALAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:525-670-1883
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:38135 MARKET SQUARE DR STE 100
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7505
Practice Address - Country:US
Practice Address - Phone:813-788-7651
Practice Address - Fax:813-355-5021
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261752800Medicaid
FLP00781676OtherRR MEDICARE
FLP00781676OtherRR MEDICARE
FL261752800Medicaid