Provider Demographics
NPI:1023109014
Name:ISLAM, MIRZA SALEEM-UL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:SALEEM-UL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:SALEEM
Other - Middle Name:
Other - Last Name:ISLAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:PO BOX 100119
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:#100119
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0119
Practice Address - Country:US
Practice Address - Phone:352-392-3718
Practice Address - Fax:352-392-9081
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME986742086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277490900Medicaid
FL277490900Medicaid