Provider Demographics
NPI:1619947652
Name:ANJUM, KAMAL (MD)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:ANJUM
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:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-1193
Mailing Address - Country:US
Mailing Address - Phone:305-332-9977
Mailing Address - Fax:954-589-0975
Practice Address - Street 1:6134 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7969
Practice Address - Country:US
Practice Address - Phone:954-589-0974
Practice Address - Fax:954-589-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80940207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59195Medicare UPIN