MEDICARE: OSAMA AL-SULEIMAN 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
1	207RI0011X	Interventional Cardiology Physician	ME86774	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	77940	OTHER	FL	MEDICARE GRP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7415255	OTHER	FL	CIGNA PROV ID #
2	P00684344	OTHER	FL	MDCRR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	57703	OTHER	FL	BCBS OF FL PROV ID #
6	CJ7430	OTHER	FL	MDCRR GRP
7	ME86774	OTHER	FL	STATE MEDICAL LICENSE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7841462	OTHER	FL	AETNA PROV ID #

General Provider Information

NPI Number	:	1770586026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSAMA AL-SULEIMAN MD

Provider Business Mailing Address
First Line	:	821 OAKLEY SEAVER DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1968
Country	:	US
Telephone Number	:	352-432-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 OAKLEY SEAVER DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1968
Country	:	US
Telephone Number	:	352-432-7200
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/20/2013

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Directions to “ OSAMA AL-SULEIMAN MD” Practice Location

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