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General NPI Number Information
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NPI Number | 1316338551
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Entity Type | Organization
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Legal Business Name | IMMINENT SURGICAL ASSOCIATES PA
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1700 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34239-3509
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Country | US
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Telephone | 941-404-6211
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Fax | 877-274-4518
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Provider Business Mailing Address
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Address Line | PO BOX 15365
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City | SARASOTA
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State | FL
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Zip | 34277-1365
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Country | US
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Telephone | 941-404-6211
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Fax | 877-274-4518
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Authorized Official
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Title or Position | OWNER
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Name | ALI ZIAD AL-RAWI
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Credential |
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Telephone | 941-404-6211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME113621
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License Number State | FL
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