Provider Demographics
NPI:1023453222
Name:BEGUM INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:BEGUM INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOHMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-695-3966
Mailing Address - Street 1:1283 SW STATE ROAD 47
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0489
Mailing Address - Country:US
Mailing Address - Phone:386-438-5255
Mailing Address - Fax:386-438-5618
Practice Address - Street 1:1283 SW STATE ROAD 47
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0489
Practice Address - Country:US
Practice Address - Phone:386-438-5255
Practice Address - Fax:386-438-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109244173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107531200Medicaid
FL008611500Medicaid