Provider Demographics
NPI:1992708168
Name:CHIDA, MUBEEN HASAN (MD)
Entity type:Individual
Prefix:
First Name:MUBEEN
Middle Name:HASAN
Last Name:CHIDA
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 1:305 N MANGOUSTINE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1004
Mailing Address - Country:US
Mailing Address - Phone:407-321-1415
Mailing Address - Fax:407-321-1597
Practice Address - Street 1:305 N MANGOUSTINE AVE
Practice Address - Street 2:STE 200
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1004
Practice Address - Country:US
Practice Address - Phone:407-321-1415
Practice Address - Fax:407-321-1597
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004826OtherFLORIDA HEALTHCARE
FL060024107OtherRAILROAD MEDICARE
FL18042OtherBCBS OF FLORIDA
FL24527OtherWELLCARE
FL274254300Medicaid
FL060024107OtherRAILROAD MEDICARE
FL18042OtherBCBS OF FLORIDA