Provider Demographics
NPI:1194701094
Name:QURESHI, MUSARRAT N (MD)
Entity type:Individual
Prefix:DR
First Name:MUSARRAT
Middle Name:N
Last Name:QURESHI
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 1:5133 SOUTH LAKELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:888-362-2343
Mailing Address - Fax:888-388-1340
Practice Address - Street 1:5133 SOUTH LAKELAND DRIVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:888-362-2343
Practice Address - Fax:888-388-1340
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME879412080P0008X
FLME 879412084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5593926OtherFIRST HEALTH
FL267392400Medicaid
FL71563OtherBLUECROSSBLUESHIELD
FLH96200Medicare UPIN