Provider Demographics
NPI:1124037007
Name:UROLOGY HEALTHCARE OF CENTRAL FLORIDA,P.A
Entity type:Organization
Organization Name:UROLOGY HEALTHCARE OF CENTRAL FLORIDA,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FAIYAAZ
Authorized Official - Middle Name:MUSTANSIR
Authorized Official - Last Name:JHAVERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-3456
Mailing Address - Street 1:2217 NORTH BOULEVARD WEST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837
Mailing Address - Country:US
Mailing Address - Phone:863-421-3456
Mailing Address - Fax:863-421-3466
Practice Address - Street 1:2217 NORTH BOULEVARD WEST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-421-3456
Practice Address - Fax:863-421-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080612208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1900258OtherUNITED HEALTHCARE
FLK1998OtherMEDICARE GROUP NUMBER
FLG73690Medicare UPIN