Provider Demographics
NPI:1679859532
Name:RAZVI, IMADUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMADUDDIN
Middle Name:
Last Name:RAZVI
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 1:14486 UNIVERSITY COVE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3740
Mailing Address - Country:US
Mailing Address - Phone:813-995-0984
Mailing Address - Fax:
Practice Address - Street 1:14486 UNIVERSITY COVE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3740
Practice Address - Country:US
Practice Address - Phone:813-995-0984
Practice Address - Fax:813-280-6193
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127044208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation