Provider Demographics
NPI:1588002505
Name:QURESHI, MOHAMMAD MASOOM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MASOOM
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8297 CHAMPIONS GATE BLVD # 463
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8387
Mailing Address - Country:US
Mailing Address - Phone:863-547-0788
Mailing Address - Fax:863-547-0789
Practice Address - Street 1:212 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-2801
Practice Address - Country:US
Practice Address - Phone:863-547-0788
Practice Address - Fax:863-547-0789
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1263962084P2900X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology