Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 004472 | GA |
N | 111NI0900X | Internist | 004472 | GA |
N | 207RH0000X | Hematologist | ME127609 | FL |
N | 207RH0003X | Hematology & Oncology | ME127609 | FL |
N | 207RH0003X | Hematology & Oncology | P9373 | TX |
Y | 207RX0202X | Medical Oncology | ME127609 | FL |
NPI | 1336466622 |
---|---|
Provider Name | Muhammad Hassaan Imam |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Orlando, FL 32804-4623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017261000 | (05) | FL |