NPIMap

Organization Active NPI

Kissimmee Primary Care/ Anti-Aging Wellness and Weight Loss Center PA

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1528212651
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ME86628 Issued in FL
Legal business name
KISSIMMEE PRIMARY CARE/ ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA
Practice address
1520 N. John Young Parkway
Kissimmee, FL 34741-3219
Phone
(407) 518-7700
Fax
(407) 518-7100
NPI assigned
Nov 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Syed Shafeeq Ur Rahman, M.D.
Title
Doctor
Phone
(407) 518-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X ME86628 FL Primary

Addresses

Primary practice location

1520 N. John Young Parkway
Kissimmee, FL 34741-3219

Mailing address

1520 N. John Young Parkway
Kissimmee, FL 34741-3219
Phone (407) 518-7700

National Provider Directory

National Provider Directory
Tax ID family
Kissimmee Primary Care Anti Aging Wellness and Weightloss Center PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1528212651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N. JOHN YOUNG PARKWAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347413219",
            "telephone_number": "407-518-7700",
            "fax_number": "407-518-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N. JOHN YOUNG PARKWAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347413219",
            "telephone_number": "407-518-7700",
            "fax_number": "407-518-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISSIMMEE PRIMARY CARE/ ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "SYED SHAFEEQ",
        "authorized_official_middle_name": "UR",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "407-518-7700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME86628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.