Provider Demographics
NPI:1801831755
Name:QUEFATIEH, AMIR (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:QUEFATIEH
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 1:6719 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2571
Mailing Address - Country:US
Mailing Address - Phone:813-782-7318
Mailing Address - Fax:813-788-5067
Practice Address - Street 1:6719 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2571
Practice Address - Country:US
Practice Address - Phone:813-782-7318
Practice Address - Fax:813-788-5067
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106326207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000016718Medicaid
DE718253510224OtherBCBS
DE2985524OtherAETNA
DE2341251OtherCIGNA
DE183577OtherCOVENTRY
DE183577OtherCOVENTRY
DEH17126Medicare UPIN