Provider Demographics
NPI:1699723619
Name:AHMAD, FAISAL (MD)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:AHMAD
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 1:1590 CHERRY LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1959
Mailing Address - Country:US
Mailing Address - Phone:407-333-0760
Mailing Address - Fax:407-936-0977
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-936-0976
Practice Address - Fax:407-936-0977
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262538500Medicaid
FL262538500Medicaid
FL35251ZMedicare PIN