Provider Demographics
NPI:1952349698
Name:YASMEEN ISLAM MD PA
Entity Type:Organization
Organization Name:YASMEEN ISLAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YASMEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-625-5855
Mailing Address - Street 1:3400 TAMIAMI TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8102
Mailing Address - Country:US
Mailing Address - Phone:941-625-5855
Mailing Address - Fax:941-625-7123
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-625-5855
Practice Address - Fax:941-625-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49858OtherBLUE CROSS
FL263441400Medicaid
FL263441400Medicaid