Provider Demographics
NPI:1669411161
Name:AFZAL, MOHAMMAD (MD MBA)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:AFZAL
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CITRUS TOWER BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1908
Mailing Address - Country:US
Mailing Address - Phone:352-394-3929
Mailing Address - Fax:352-394-6446
Practice Address - Street 1:265 CITRUS TOWER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1908
Practice Address - Country:US
Practice Address - Phone:352-394-3929
Practice Address - Fax:352-394-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 72542208000000X
UT3193271205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260332200Medicaid
FL593711113OtherTRICARE
FL516574Medicare PIN
H313420001Medicare UPIN
FL108981Medicare Oscar/Certification