Provider Demographics
NPI:1972119113
Name:REZAHI, ABDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:REZAHI
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 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:407-931-0444
Mailing Address - Fax:407-962-4446
Practice Address - Street 1:6210 W COLONIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7504
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-652-5207
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1323208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice