1023109014 NPI number — DR. MIRZA SALEEM-UL ISLAM M.D., M.P.H.

Table of content: DR. MIRZA SALEEM-UL ISLAM M.D., M.P.H. (NPI 1023109014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023109014 NPI number — DR. MIRZA SALEEM-UL ISLAM M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISLAM
Provider First Name:
MIRZA
Provider Middle Name:
SALEEM-UL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ISLAM
Provider Other First Name:
SALEEM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., M.P.H.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023109014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
#100119
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-0119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-392-3718
Provider Business Practice Location Address Fax Number:
352-392-9081
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X , with the licence number:  ME98674 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 277490900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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