Provider Demographics
NPI:1669455168
Name:CHOUDHURY, ASIF H (MD)
Entity Type:Individual
Prefix:
First Name:ASIF
Middle Name:H
Last Name:CHOUDHURY
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 1:14131 METROPOLIS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4455
Mailing Address - Country:US
Mailing Address - Phone:239-415-2273
Mailing Address - Fax:239-415-2280
Practice Address - Street 1:14131 METROPOLIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4455
Practice Address - Country:US
Practice Address - Phone:239-415-2273
Practice Address - Fax:239-415-2280
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67705Medicare UPIN
FL35283BMedicare PIN