Provider Demographics
NPI:1700078979
Name:FALCON MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FALCON MEDICAL GROUP INC
Other - Org Name:FALCON SLEEP AND NEURODIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:U
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-314-9071
Mailing Address - Street 1:6000 METROWEST BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7630
Mailing Address - Country:US
Mailing Address - Phone:407-365-3033
Mailing Address - Fax:407-365-3034
Practice Address - Street 1:6000 METROWEST BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7630
Practice Address - Country:US
Practice Address - Phone:407-365-3033
Practice Address - Fax:407-365-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102387207RS0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000042800Medicaid
FLAL169Medicare PIN