Healthcare Provider Details

I. General information

NPI: 1851371405
Provider Name (Legal Business Name): ASAF ALEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 PRESIDENTIAL CT STE 3
FORT MYERS FL
33919-3501
US

IV. Provider business mailing address

2150 PEACHFORD RD STE H
ATLANTA GA
30327
US

V. Phone/Fax

Practice location:
  • Phone: 786-377-5643
  • Fax:
Mailing address:
  • Phone: 770-454-1252
  • Fax: 770-454-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME131514
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number030260
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: