Provider Demographics
NPI:1487942009
Name:AZAD, KAMRAN JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:JUSTIN
Last Name:AZAD
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 1:8469 NEMOURS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7753
Mailing Address - Country:US
Mailing Address - Phone:914-806-0653
Mailing Address - Fax:
Practice Address - Street 1:954 S ORLANDO AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4849
Practice Address - Country:US
Practice Address - Phone:407-848-3400
Practice Address - Fax:407-602-0901
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X2086S0122X
FLME135792208200000X
CAA128991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist