Provider Demographics
NPI:1730107780
Name:PREMCARE FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:PREMCARE FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-380-1428
Mailing Address - Street 1:4501 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2407
Mailing Address - Country:US
Mailing Address - Phone:407-380-1428
Mailing Address - Fax:407-380-0754
Practice Address - Street 1:4501 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2407
Practice Address - Country:US
Practice Address - Phone:407-380-1428
Practice Address - Fax:407-380-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG17384Medicare UPIN