Organization Name: | KISSIMMEE PRIMARY CARE/ ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA |
NPI Number: | 1528212651 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SYED SHAFEEQ UR RAHMAN (DOCTOR) |
Mailing Address: | 1520 N. John Young Parkway Kissimmee |
State: | FL US |
Postal Code: | 347413219 |
Phone Number: | 4075187700 |
Fax Number: | 4075187100 |
NPI Enumeration Date: | 11/17/2008 |
NPI Last Update Date: | 04/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME86628 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |