Healthcare Provider Details

I. General information

NPI: 1053575167
Provider Name (Legal Business Name): A SULTAN LALANI M D LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 S AVENUE A STE B
YUMA AZ
85364-8458
US

IV. Provider business mailing address

2175 S AVENUE A STE B
YUMA AZ
85364-8458
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-7811
  • Fax: 928-783-0036
Mailing address:
  • Phone: 928-783-7811
  • Fax: 928-783-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD10298
License Number StateAZ

VIII. Authorized Official

Name: DR. ABDUL SULTAN LALANI I
Title or Position: OTOLARYNGOLOGY
Credential: M.D.
Phone: 928-783-7811