Provider Demographics
NPI:1851426274
Name:PROACTIVE MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:PROACTIVE MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUAYAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-268-1346
Mailing Address - Street 1:3001 N ROCKY POINT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5802
Mailing Address - Country:US
Mailing Address - Phone:800-268-1346
Mailing Address - Fax:800-809-6184
Practice Address - Street 1:3001 N ROCKY POINT DR
Practice Address - Street 2:STE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5802
Practice Address - Country:US
Practice Address - Phone:800-268-1346
Practice Address - Fax:800-809-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1025622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty