Provider Demographics
NPI:1649784489
Name:PHOENIX AMERICAN MEDICAL LLC
Entity type:Organization
Organization Name:PHOENIX AMERICAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUFTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-277-5348
Mailing Address - Street 1:14690 SPRING HILL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-428-7817
Mailing Address - Fax:352-797-2491
Practice Address - Street 1:1030 S 78TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4750
Practice Address - Country:US
Practice Address - Phone:813-740-0646
Practice Address - Fax:813-609-3733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIFA HEALTHCARE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty