Basic Information
| Provider Information | |||||||||
| NPI: | 1730156936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIDER | ||||||||
| FirstName: | ABDULLAH | ||||||||
| MiddleName: | TAMIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 8TH AVE W | ||||||||
| Address2: | STE101 | ||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342214737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764008 | ||||||||
| FaxNumber: | 9418454963 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 ROTANZI ST | ||||||||
| Address2: | |||||||||
| City: | RAMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920652583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607366767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0071570 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1882193 | 01 | FL | MEDICARE COMPLETE | OTHER | 251641100 | 05 | FL | MEDICAID | 301386 | 01 | FL | WELLCARE URGENT CARE | OTHER | 203122 | 01 | FL | AMERIGROUP | OTHER | 229615 | 01 | FL | AMERIGROUP URGENT CARE | OTHER | P102133 | 01 | FL | FREEDOM HEALTH | OTHER | 80115985 | 01 | FL | RAILROAD | OTHER | 00464 | 01 | FL | UNIVERSAL | OTHER | 191968 | 01 | FL | WELLCARE | OTHER |