Provider Demographics
NPI:1730167263
Name:ATIQUZZAMAN, TAHSINA Y (MD)
Entity type:Individual
Prefix:DR
First Name:TAHSINA
Middle Name:Y
Last Name:ATIQUZZAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:505 W OAK ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4986
Mailing Address - Country:US
Mailing Address - Phone:407-846-6331
Mailing Address - Fax:407-846-0137
Practice Address - Street 1:505 W OAK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4986
Practice Address - Country:US
Practice Address - Phone:407-846-6331
Practice Address - Fax:407-846-0137
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274425200Medicaid
FL274425200Medicaid