Provider Demographics
NPI:1538444344
Name:ABDUL S. AGHA, M.D., PA
Entity type:Organization
Organization Name:ABDUL S. AGHA, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-2041
Mailing Address - Street 1:6701 SUNSET DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4529
Mailing Address - Country:US
Mailing Address - Phone:305-661-2041
Mailing Address - Fax:305-663-1015
Practice Address - Street 1:6701 SUNSET DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-661-2041
Practice Address - Fax:305-663-1015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABDUL S. AGHA , M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035602600Medicaid
FLD59543Medicare UPIN
FL91213Medicare PIN