Provider Demographics
NPI:1285346544
Name:VANTAGE MEDICAL GROUP
Entity type:Organization
Organization Name:VANTAGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:KAFEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-688-2534
Mailing Address - Street 1:PO BOX 6054
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-6054
Mailing Address - Country:US
Mailing Address - Phone:917-688-2534
Mailing Address - Fax:
Practice Address - Street 1:15806 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1641
Practice Address - Country:US
Practice Address - Phone:917-688-2534
Practice Address - Fax:800-420-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty