Provider Demographics
NPI:1154795565
Name:FAISAL TAWWAB, M.D., LLC
Entity type:Organization
Organization Name:FAISAL TAWWAB, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-330-8377
Mailing Address - Street 1:PO BOX 5668
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32728-5668
Mailing Address - Country:US
Mailing Address - Phone:407-330-8377
Mailing Address - Fax:
Practice Address - Street 1:780 DELTONA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7128
Practice Address - Country:US
Practice Address - Phone:407-330-8377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty