Provider Demographics
NPI:1669486379
Name:MOHIB, SAIYED AONALI (MD)
Entity Type:Individual
Prefix:
First Name:SAIYED
Middle Name:AONALI
Last Name:MOHIB
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 1:1417 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3200
Mailing Address - Country:US
Mailing Address - Phone:863-682-8401
Mailing Address - Fax:863-802-9611
Practice Address - Street 1:410 LIONEL WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7809
Practice Address - Country:US
Practice Address - Phone:352-432-7200
Practice Address - Fax:352-432-7070
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109212207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004729800Medicaid
IL036109212Medicaid
FL004729800Medicaid
K20399Medicare ID - Type Unspecified
FLFZ644WMedicare PIN