1770586026 NPI number — OSAMA AL-SULEIMAN MD

Table of content: OSAMA AL-SULEIMAN MD (NPI 1770586026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770586026 NPI number — OSAMA AL-SULEIMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-SULEIMAN
Provider First Name:
OSAMA
Provider Middle Name:
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:
1770586026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 OAKLEY SEAVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-432-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 OAKLEY SEAVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-432-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2005

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: 207RI0011X , with the licence number:  ME86774 , 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: 7415255 . This is a "CIGNA PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00684344 . This is a "MDCRR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266607300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 77940 . This is a "MEDICARE GRP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57703 . This is a "BCBS OF FL PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CJ7430 . This is a "MDCRR GRP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME86774 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269859500 . This is a "MEDICAID GRP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7841462 . This is a "AETNA PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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