Provider Demographics
NPI:1629142302
Name:BAIG, AJMAL A (MD)
Entity Type:Individual
Prefix:
First Name:AJMAL
Middle Name:A
Last Name:BAIG
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 1:17222 HOSPITAL BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-544-6145
Mailing Address - Fax:352-688-9189
Practice Address - Street 1:17222 HOSPITAL BLVD STE 242
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-544-6145
Practice Address - Fax:352-688-9189
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113869400Medicaid
FLO6196OtherMEDICARE
FL273642000Medicaid
FL28706YMedicare PIN