Healthcare Provider Details

I. General information

NPI: 1518217561
Provider Name (Legal Business Name): SADI A ABUSRUR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3037
US

IV. Provider business mailing address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3037
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-8990
  • Fax: 407-730-5936
Mailing address:
  • Phone: 407-704-8990
  • Fax: 407-730-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME33741
License Number StateFL

VIII. Authorized Official

Name: DR. SADI A ABUSRUR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 407-704-8990