Provider Demographics
NPI:1932117710
Name:NAEEM, MOHTASHIM (MD)
Entity Type:Individual
Prefix:
First Name:MOHTASHIM
Middle Name:
Last Name:NAEEM
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 1:401 NW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2835
Mailing Address - Country:US
Mailing Address - Phone:954-513-6655
Mailing Address - Fax:
Practice Address - Street 1:401 NW 42ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2835
Practice Address - Country:US
Practice Address - Phone:954-513-6655
Practice Address - Fax:954-513-6451
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22160207ZP0101X, 207ZP0105X
FLME108452207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00341662OtherRAILROAD MEDICARE
OH2666691Medicaid
WV3810005839Medicaid
WV3810005839Medicaid
I58746Medicare UPIN
OH7364911Medicare PIN