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General NPI Number Information
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NPI Number | 1932403607
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Entity Type | Organization
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Legal Business Name | INNOVATION MEDICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 350 7TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-5754
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Country | US
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Telephone | 239-919-2959
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Fax |
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Provider Business Mailing Address
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Address Line | 16018 VIA SOLERA CIR APT 105
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City | FORT MYERS
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State | FL
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Zip | 33908-3774
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Country | US
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Telephone | 239-919-2959
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI A SULTAN
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Credential | M.D
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Telephone | 239-919-2959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME96258
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License Number State | FL
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