Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME131131 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME131131 | FL |
NPI | 1124361431 |
---|---|
Provider Name | Bilal Islam |
First Address | Lynn Haven, FL 32444-4701 |
Second Address | Lynn Haven, FL 32444-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 17/08/2021 |