Provider Demographics
NPI:1073502225
Name:PARVEEN, KAUSAR (MD)
Entity type:Individual
Prefix:
First Name:KAUSAR
Middle Name:
Last Name:PARVEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KINGSGATE CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2381 MASON AVE STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5161
Practice Address - Country:US
Practice Address - Phone:386-671-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5290YOtherMEDICARE ID
FLME0069316OtherDCWO
FLME0069316OtherVHN
FLME0069316OtherUNITED BENEFITS
FL71006OtherBCBS
FL110247957OtherRAILROAD
FLE5290YOtherMEDICARE ID
FLME0069316OtherVHN