Provider Demographics
NPI:1285927277
Name:TAWWAB, FAISAL (MD)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:TAWWAB
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 1:2605 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3568
Mailing Address - Country:US
Mailing Address - Phone:407-878-7990
Mailing Address - Fax:
Practice Address - Street 1:2605 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3568
Practice Address - Country:US
Practice Address - Phone:407-878-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46367207Q00000X, 208M00000X
FLME123545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01196100OtherRAILROAD MEDICARE
KY7100216480Medicaid
FLIN472XMedicare PIN
KYK054050Medicare PIN
KYK054051Medicare PIN
FLIN472YMedicare PIN
KYK054053Medicare PIN