Provider Demographics
NPI:1922093079
Name:FLORIDA PULMONARY CONSULTANTS PA
Entity Type:Organization
Organization Name:FLORIDA PULMONARY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-740-5447
Mailing Address - Street 1:1788 W FAIRBANKS AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4681
Mailing Address - Country:US
Mailing Address - Phone:407-740-5447
Mailing Address - Fax:407-740-5532
Practice Address - Street 1:1788 W FAIRBANKS AVE
Practice Address - Street 2:STE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4681
Practice Address - Country:US
Practice Address - Phone:407-740-5447
Practice Address - Fax:407-740-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290002724OtherRAILROAD MEDICARE B
FL370289800Medicaid
FL290002724OtherRAILROAD MEDICARE B