Organization
CLINICAL GI AND HEPATOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHMUDUL HAQ M.D, MSC (OWNER)
(407) 760-4598
Entity
Organization
Contact information
Practice address
1648 DERBY GLEN DR, ORLANDO, FL 32837-8131
(407) 760-4598
Mailing address
1648 DERBY GLEN DR, ORLANDO, FL 32837-8131
(407) 760-4598
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109395700
—
FL
01
—
14LIJ
BCBS
FL
Enumeration date
05/04/2017
Last updated
12/01/2021
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