=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023540036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABBAS S ALI MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2017
-----------------------------------------------------
Last Update Date | 03/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3190 CITRUS TOWER BLVD STE A
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-6886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-843-5723
-----------------------------------------------------
Fax | 407-641-8835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7512 DR PHILLIPS BLVD STE 50-137
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-5420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-843-5723
-----------------------------------------------------
Fax | 407-641-8835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | ABBAS S ALI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-467-6604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------