Provider Demographics
NPI:1861428260
Name:MUKAYED, USAMA (MD)
Entity type:Individual
Prefix:DR
First Name:USAMA
Middle Name:
Last Name:MUKAYED
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 1:5800 49TH ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2100
Mailing Address - Country:US
Mailing Address - Phone:727-521-4995
Mailing Address - Fax:727-289-3240
Practice Address - Street 1:5800 49TH ST N STE 204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2100
Practice Address - Country:US
Practice Address - Phone:727-521-4995
Practice Address - Fax:727-289-3240
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051285207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010022920OtherRAILROAD MEDICARE PIN
FL061768700Medicaid
010022920OtherRAILROAD MEDICARE PIN
FL061768700Medicaid