Provider Demographics
NPI:1700854031
Name:FAMILY CARE SPECIALISTS OF ORLANDO
Entity Type:Organization
Organization Name:FAMILY CARE SPECIALISTS OF ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:QAYYUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-952-2320
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-355-7759
Mailing Address - Fax:407-355-4987
Practice Address - Street 1:7932 W SAND LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7263
Practice Address - Country:US
Practice Address - Phone:407-355-7759
Practice Address - Fax:407-355-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-11
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2526Medicare ID - Type Unspecified