Provider Demographics
NPI:1619931516
Name:GHUMMAN, WAQAS A (MD)
Entity Type:Individual
Prefix:
First Name:WAQAS
Middle Name:A
Last Name:GHUMMAN
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 1:180 JFK DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6641
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-434-5165
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6641
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-434-5165
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052070A204F00000X, 207RC0000X, 207RC0001X, 207RC0200X, 2086S0129X
FLME126314207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375660Medicaid
INP01214639OtherRR MEDICARE PTAN
INP01214639OtherRR MEDICARE PTAN
IN266180178Medicare PIN
IN251320HHHMedicare PIN