SYED TARIQ MUMTAZ MD PA
Suppliers at Cypress Pkwy, Kissimmee, FL

License number
Florida ME70936
Category
Suppliers
Type
Non-Pharmacy Dispensing Site
Owner
Name: KENNY HEINE
Title: VP OF OPERATIONS
Phone: (858) 964-1506
Address
Address 2
1000 Cypress Pkwy, Kissimmee, FL 34759
5626 Oberlin Dr SUITE 110, San Diego, CA 92121
National Provider ID: 1235569963
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about SYED TARIQ MUMTAZ MD PA at bizstanding.com

SYED TARIQ MUMTAZ, M.D., PA

Kissimmee, FL

Status:
Inactive
Inactive reason:
Reinstatement
Registration:
Aug 7, 1998
Inactive since:
Feb 12, 2004
Addresses:
724 W Vine St, Kissimmee, FL 34741 (Physical)
423 W Vine St, Kissimmee, FL 34741
403 W Oak St, Kissimmee, FL 34741
State ID:
P98000070071
Business type:
Florida Profit Corporation
Director:
Syed T Mumtaz (Director), 724 W Vine St, Kissimmee, FL 34741 (Physical)
Agent:
Syed Mumtaz,724 W Vine St, Kissimmee, FL 34741 (Physical)
EIN:
59-3525369

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