Provider Demographics
NPI:1275677254
Name:MIDTOWN CLINIC, PA
Entity Type:Organization
Organization Name:MIDTOWN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-788-5524
Mailing Address - Street 1:5821 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-3455
Mailing Address - Country:US
Mailing Address - Phone:813-788-5524
Mailing Address - Fax:813-780-6472
Practice Address - Street 1:5821 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3455
Practice Address - Country:US
Practice Address - Phone:813-788-5524
Practice Address - Fax:813-780-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62374Medicare UPIN
FL33374Medicare PIN