Provider Demographics
NPI:1467786046
Name:CHUGHTAI, HAROON LATIF (MD)
Entity type:Individual
Prefix:
First Name:HAROON
Middle Name:LATIF
Last Name:CHUGHTAI
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 1:305. N MANGOUSTINE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:321-363-9335
Mailing Address - Fax:321-219-9930
Practice Address - Street 1:305. N MANGOUSTINE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:321-363-9335
Practice Address - Fax:321-219-9930
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094340207R00000X
WI60844-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467786046Medicaid