Provider Demographics
NPI:1386997427
Name:GASTROENTEROLOGY ASSOCIATES OF OSCEOLA, PA
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF OSCEOLA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-846-6747
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:710 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4100
Practice Address - Country:US
Practice Address - Phone:407-846-6747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTROENTEROLOGY ASSOCIATES OF OSCEOLA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site