Provider Demographics
NPI:1649255373
Name:MIN, ZAW (MD)
Entity type:Individual
Prefix:
First Name:ZAW
Middle Name:
Last Name:MIN
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 1:2600 S DOUGLAS RD
Mailing Address - Street 2:STE 308
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:863-686-2728
Mailing Address - Fax:863-686-6737
Practice Address - Street 1:135 E. FIRST STREET
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4609
Practice Address - Country:US
Practice Address - Phone:863-686-2728
Practice Address - Fax:863-686-6737
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0086989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266859900Medicaid
H86513Medicare UPIN
FL266859900Medicaid