Healthcare Provider Details

I. General information

NPI: 1023443074
Provider Name (Legal Business Name): ASHRAF JMEIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ASHRAF SAMI BOTROS JMEIAN M.D.

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WILLISTON PARK PT STE 1000
LAKE MARY FL
32746-2163
US

IV. Provider business mailing address

PO BOX 947313
ATLANTA GA
30394-7313
US

V. Phone/Fax

Practice location:
  • Phone: 407-833-8028
  • Fax: 407-833-8033
Mailing address:
  • Phone: 386-231-3619
  • Fax: 386-672-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME164852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: