Provider Demographics
NPI:1588307094
Name:MID-FLORIDA GROUP OF SPECIALISTS LLC
Entity type:Organization
Organization Name:MID-FLORIDA GROUP OF SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-364-0728
Mailing Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:321-364-0728
Practice Address - Fax:321-364-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME94056Medicaid
FLME125151Medicaid
FLME94056OtherCOMMERCIAL
FLME128664OtherCOMMERCIAL
FL019373400Medicaid
FLME128664Medicaid
FLME125151OtherCOMMERCIAL