MEDICARE: DR. SARI ALI NABULSI M.D.

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	208000000X	Pediatrics Physician	K6175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2313762	OTHER	TX	CIGNA
3	H1844426	OTHER	TX	UNITED HEALTHCARE
4	5135595	OTHER	TX	AETNA
5	122477	OTHER	TX	CHIPS
6	8G9660	OTHER	TX	BLUE CROSS BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740289297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARI ALI NABULSI M.D.

Provider Business Mailing Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:	432-699-4134

Provider Business Practice Location Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:	432-699-4134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/05/2013

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