Provider Demographics
NPI:1831234897
Name:HAMTAEE, MOHAMMAD MEHDI (DC)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MEHDI
Last Name:HAMTAEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1118
Mailing Address - Country:US
Mailing Address - Phone:863-688-2200
Mailing Address - Fax:863-688-2210
Practice Address - Street 1:1048 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1118
Practice Address - Country:US
Practice Address - Phone:863-688-2200
Practice Address - Fax:863-688-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382160900Medicaid
FLAQ271ZMedicare PIN