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General NPI Number Information
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NPI Number | 1508999673
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Entity Type | Organization
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Legal Business Name | PULMONARY CRITICAL CARE & SLEEP SPECIALISTS OF LAKE COUNTY, PA
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 2762 DORA AVE
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City | TAVARES
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State | FL
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Zip | 32778-4970
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Country | US
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Telephone | 352-508-1727
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Fax | 877-762-7377
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | TAVARES
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State | FL
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Zip | 32778-0386
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Country | US
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Telephone | 352-508-1727
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Fax | 877-762-7377
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Authorized Official
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Title or Position | OWNER
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Name | AHMAD JALLOUL
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Credential | MD
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Telephone | 352-508-1727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME97922
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License Number State | FL
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