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NPI Code Detail

MEDICARE: SAADIA FERSOBE MD

MEDICARE:   SAADIA  FERSOBE  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianACN684FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ACN684OTHERFLFLORIDA LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013170893
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAADIA FERSOBE MD
Provider Business Mailing Address
First Line : 13403 FAIRWAY GLEN DR
Second Line : APT 102
City : ORLANDO
State : FL
Zip : 32824-5026
Country : US
Telephone Number : 646-243-8363
Fax Number :
Provider Business Practice Location Address
First Line : 804 EMMETT ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-5434
Country : US
Telephone Number : 407-749-0380
Fax Number : 407-569-4149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2008
Last Update Date : 03/17/2018

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Directions to “ SAADIA FERSOBE MD” Practice Location

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