Provider Demographics
NPI:1639395403
Name:ARIFUDDIN, RIAZ (MD)
Entity Type:Individual
Prefix:
First Name:RIAZ
Middle Name:
Last Name:ARIFUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 N POWERS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3240
Mailing Address - Country:US
Mailing Address - Phone:407-291-9688
Mailing Address - Fax:407-339-6053
Practice Address - Street 1:2809 N POWERS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3240
Practice Address - Country:US
Practice Address - Phone:407-291-9688
Practice Address - Fax:407-339-6053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068126100Medicaid
FL068126100Medicaid