Provider Demographics
NPI:1366404642
Name:AKHTAR, ADNAN (MD)
Entity type:Individual
Prefix:
First Name:ADNAN
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 MEDICAL CENTER DR.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8200
Mailing Address - Country:US
Mailing Address - Phone:386-917-7630
Mailing Address - Fax:386-917-7635
Practice Address - Street 1:1300 W. OAK STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-944-5240
Practice Address - Fax:407-944-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73723207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42431XMedicare ID - Type Unspecified
G63662Medicare UPIN