Provider Demographics
NPI:1952624355
Name:AKHTAR, MUHAMMAD I (MD)
Entity type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:I
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COLLEGE DR UNIT 65301
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7813
Mailing Address - Country:US
Mailing Address - Phone:904-368-6809
Mailing Address - Fax:
Practice Address - Street 1:2140 KINGSLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-368-6809
Practice Address - Fax:904-368-6819
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2024-10-18
Deactivation Date:2024-08-13
Deactivation Code:
Reactivation Date:2024-09-19
Provider Licenses
StateLicense IDTaxonomies
FLME86998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262561000Medicaid
FL262561000Medicaid