Provider Demographics
NPI:1154709608
Name:GHANEM, MUHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:GHANEM
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 1:89 W COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2002
Mailing Address - Country:US
Mailing Address - Phone:321-843-8900
Mailing Address - Fax:352-629-3145
Practice Address - Street 1:89 W COPELAND DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2002
Practice Address - Country:US
Practice Address - Phone:321-843-8900
Practice Address - Fax:352-629-3145
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2020-10-26
Deactivation Date:2015-12-28
Deactivation Code:
Reactivation Date:2016-02-25
Provider Licenses
StateLicense IDTaxonomies
TXBP10061609208600000X
FLME143723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105984800Medicaid