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General NPI Number Information
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NPI Number | 1396250965
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Entity Type | Organization
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Legal Business Name | FITZGERALD SURGICAL, PLLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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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 | 941-961-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 LAZY OAKS WAY
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City | SAINT CLOUD
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State | FL
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Zip | 34771-8843
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALI AL-RAWI
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Credential | MD
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Telephone | 941-961-3050
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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 | 114954
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License Number State | FL
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