10D1104331 CLIA NUMBER - SYED T MUMTAZ MD PA

Laboratory Demographics

CLIA Number: 10D1104331

Facility Name: SYED T MUMTAZ MD PA

Facility Address:
1000 CYPRESS PARKWAY
KISSIMMEE, FL
ZIP 34741
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Facility Phone Number: 407 944-4450

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053346148

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D1104331
LAB Type	Physician Office
Facility Name	SYED T MUMTAZ MD PA
Street	1000 CYPRESS PARKWAY
City	KISSIMMEE
State	FL
ZIP	34741
Phone	407 944-4450
CertificateType	4
CertificateEffectiveDate	9/1/2023
CertificateExpirationDate	8/31/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024