MEDICARE: PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC

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
1	207RP1001X	Pulmonary Disease Physician	ME 100366	FL

General Provider Information

NPI Number	:	1396981635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC

Provider Business Mailing Address
First Line	:	5454 CENTRAL AVE STE A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-6129
Country	:	US
Telephone Number	:	727-347-5242
Fax Number	:	727-347-2402

Provider Business Practice Location Address
First Line	:	5454 CENTRAL AVE STE A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-6129
Country	:	US
Telephone Number	:	727-347-5242
Fax Number	:	727-347-2402

Authorized Official
Title or Position	:	OWNER/MD
Name	:	MOHAMED IBRAHIM ALI ELTOUM
Credential	:	MD
Telephone Number	:	727-347-5242

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	03/19/2024

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