# KISSIMMEE PRIMARY CARE/ ANTI-AGING WELLNESS AND WEIGHT LOSS CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528212651
- **Authorized official:** SYED SHAFEEQ UR RAHMAN M.D. (DOCTOR)
- **Authorized official phone:** (407) 518-7700

## Contact information

- **Practice address:** 1520 N. JOHN YOUNG PARKWAY, KISSIMMEE, FL 34741-3219
- **Practice address phone:** (407) 518-7700
- **Practice address fax:** (407) 518-7100
- **Mailing address:** 1520 N. JOHN YOUNG PARKWAY, KISSIMMEE, FL 34741-3219
- **Mailing address phone:** (407) 518-7700
- **Mailing address fax:** (407) 518-7100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME86628 | FL | Yes |

## Other

- **Enumeration date:** 11/17/2008
- **Last updated:** 04/21/2009