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General NPI Number Information
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NPI Number | 1336313550
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE CARDIOLOGY, LLC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 3150 CITRUS TOWER BLVD BUILDING 13, SUITE B
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City | CLERMONT
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State | FL
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Zip | 34711-6802
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Country | US
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Telephone | 407-467-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 CITRUS TOWER BLVD BUILDING 13, SUITE B
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City | CLERMONT
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State | FL
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Zip | 34711-6802
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Country | US
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Telephone | 407-467-1234
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | OSAMA F AL-SULEIMAN
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Credential | M.D.
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Telephone | 407-467-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME86774
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License Number State | FL
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