Individual
ABDIMOMUN IULDASHEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
Mailing address
86 W UNDERWOOD ST, MP 80, ORLANDO, FL 32806-2008
(888) 912-3648
(321) 841-4085
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME128107
FL
208M00000X
Hospitalist Physician
Primary
ME128107
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017429000
—
FL
01
—
MU842
MEDICARE HF
FL
Enumeration date
04/22/2013
Last updated
09/21/2020
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