Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME 109667 | FL |
Y | 111NI0900X | Internist | ME 109667 | FL |
NPI | 1003115098 |
---|---|
Provider Name | Dr. Amir Hesam Etemadnia |
First Address | The Villages, FL 32159-6827 |
Second Address | Leesburg, FL 34748-3850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 13/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FM003Z | PTAN (01) | FL |