Provider Demographics
NPI:1972595254
Name:TAQI, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:TAQI
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-5159
Mailing Address - Fax:978-926-5620
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5159
Practice Address - Fax:978-926-5620
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067902207Q00000X, 207R00000X
FLME94185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104208788Medicaid
MI104208803Medicaid
MI104208812Medicaid
MI104292342Medicaid
FL277547600Medicaid
MI08-0-14-0020OtherBCBSM
MI700A460030OtherBCBSM- GROUP
MI104208812Medicaid
MI700A460030OtherBCBSM- GROUP
MI104292342Medicaid
FLAC088UMedicare PIN
FLAC088ZMedicare PIN