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General NPI Number Information
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NPI Number | 1336426295
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Entity Type | Organization
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Legal Business Name | ISSA F BAROUDI MD PA
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 3222 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8048
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Country | US
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Telephone | 941-627-5155
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Fax | 941-629-5317
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Provider Business Mailing Address
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Address Line | 3222 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8048
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Country | US
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Telephone | 941-627-5155
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Fax | 941-629-5317
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ISSA F BAROUDI
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Credential | MD
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Telephone | 941-627-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME38318
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License Number State | FL
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