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General NPI Number Information
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NPI Number | 1952325490
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF CARDIOVASCULAR MEDICINE LLC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 10435 SE 170TH PL
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8998
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Country | US
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Telephone | 352-347-7923
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Fax | 352-347-6181
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Provider Business Mailing Address
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Address Line | PO BOX 919298
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City | ORLANDO
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State | FL
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Zip | 32891-9298
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Country | US
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Telephone | 352-624-7384
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Fax | 352-624-7385
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALI NASSER
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Credential | M.D.
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Telephone | 352-291-0166
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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 |
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License Number State | FL
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