Provider Demographics
NPI:1679689590
Name:BAWANY, MOHAMMED H (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:H
Last Name:BAWANY
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 1:716 SOUTH GOLDENROD ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822
Mailing Address - Country:US
Mailing Address - Phone:407-658-1719
Mailing Address - Fax:407-658-2536
Practice Address - Street 1:716 SOUTH GOLDENROD ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-658-1719
Practice Address - Fax:407-658-2536
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259027100Medicaid
FL593543941Medicare PIN
FL51790BMedicare PIN
D28885Medicare UPIN