Active NPI
M. Siraj Ul Islam, M.D.
- Gastroenterology Physician
- Kissimmee, FL
National Provider Identifier
1699719187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- ME0048529
- Practice address
- 710 Oak Commons Blvd
Kissimmee, FL 34741-4100 - Phone
- (407) 518-1199
- Fax
- (407) 569-1201
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | ME0048529 | FL | Primary |
Addresses
Primary practice location
710 Oak Commons Blvd
Kissimmee, FL 34741-4100
Mailing address
PO Box 423009
Kissimmee, FL 34742-3009
Phone (407) 518-1199
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 045481800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0048529 | FL | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342656000000",
"number": "1699719187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 423009",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347423009",
"telephone_number": "407-518-1199",
"fax_number": "407-569-1201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 OAK COMMONS BLVD",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347414100",
"telephone_number": "407-518-1199",
"fax_number": "407-569-1201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISLAM",
"first_name": "M.",
"middle_name": "SIRAJ UL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2012-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "FL",
"license": "ME0048529",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "045481800",
"state": "FL"
}
],
"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 Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.