Provider Demographics
NPI:1194930198
Name:SMADI, YAMEN (MD)
Entity type:Individual
Prefix:
First Name:YAMEN
Middle Name:
Last Name:SMADI
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 1:60 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1141
Mailing Address - Country:US
Mailing Address - Phone:321-841-3338
Mailing Address - Fax:321-841-2170
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1141
Practice Address - Country:US
Practice Address - Phone:321-841-3338
Practice Address - Fax:321-841-2170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117408208000000X, 2080P0206X
MI4301086030208000000X
SD7325208000000X
FLTRN18047390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009606900Medicaid
FL009606900Medicaid
SDS102654Medicare PIN