Provider Demographics
NPI:1194907667
Name:BOLAD, WALEED ABBAS (MD)
Entity type:Individual
Prefix:DR
First Name:WALEED
Middle Name:ABBAS
Last Name:BOLAD
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 1:207 W GORE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1008
Mailing Address - Country:US
Mailing Address - Phone:407-409-8118
Mailing Address - Fax:407-264-6562
Practice Address - Street 1:5750 MAJOR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7971
Practice Address - Country:US
Practice Address - Phone:407-409-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120763207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ618ZOtherMEDICARE PTAN
FL014446200Medicaid