1528067386 NPI number — SAMI F MUHTADIE MD

Table of content: SAMI F MUHTADIE MD (NPI 1528067386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528067386 NPI number — SAMI F MUHTADIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUHTADIE
Provider First Name:
SAMI
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528067386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 BROTHER GEENEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34236-7102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-556-3233
Provider Business Mailing Address Fax Number:
941-955-8214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 BROTHER GEENEN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-556-3233
Provider Business Practice Location Address Fax Number:
941-955-8214
Provider Enumeration Date:
07/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  LL744 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 370006486 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0159055 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000012207 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 010374100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".