Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME98674 | FL |
NPI | 1023109014 |
---|---|
Provider Name | Dr. Mirza Saleem-Ul Islam |
First Address | Gainesville, FL 32610-0119 |
Second Address | Gainesville, FL 32610-0119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 06/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
277490900 | (05) | FL |
AC364Z | (02) | FL |