Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME131887 | FL |
N | 111NI0900X | Internist | ME131887 | FL |
N | 207RC0000X | Internist - Cardiovascular Disease | ME131887 | FL |
Y | 207RI0011X | Interventional Cardiology | ME131887 | FL |
NPI | 1063831261 |
---|---|
Provider Name | Dr. Kerolos Fahmi |
First Address | Brandon, FL 33511-5911 |
Second Address | Brandon, FL 33511-5911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 25/06/2021 |