Provider Demographics
NPI:1235572405
Name:HEART AND VASCULAR CLINIC OF CLERMONT LLC
Entity Type:Organization
Organization Name:HEART AND VASCULAR CLINIC OF CLERMONT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL SULEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-467-1234
Mailing Address - Street 1:821 OAKLEY SEAVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1968
Mailing Address - Country:US
Mailing Address - Phone:352-432-7200
Mailing Address - Fax:
Practice Address - Street 1:821 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:352-432-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86774207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty