Provider Demographics
NPI:1558618835
Name:SYED TARIQ MUMTAZ, MD, PA
Entity Type:Organization
Organization Name:SYED TARIQ MUMTAZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:T
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-944-4450
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:724 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4161
Practice Address - Country:US
Practice Address - Phone:407-944-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYED TARIQ MUMTAZ, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site