Provider Demographics
NPI:1518043108
Name:AWAN, MUHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:A
Last Name:AWAN
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 1:4501 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2407
Mailing Address - Country:US
Mailing Address - Phone:407-380-1428
Mailing Address - Fax:407-380-0754
Practice Address - Street 1:4501 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2407
Practice Address - Country:US
Practice Address - Phone:407-380-1428
Practice Address - Fax:407-380-0754
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068874174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378958600Medicaid
FL27840SMedicare PIN
FL378958600Medicaid