Provider Demographics
NPI:1255656203
Name:IDREES-ASAD, NOUREEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:NOUREEN
Middle Name:S
Last Name:IDREES-ASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 TOWN CENTER RD #20
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1009
Mailing Address - Country:US
Mailing Address - Phone:561-391-6210
Mailing Address - Fax:561-391-2810
Practice Address - Street 1:5458 TOWN CENTER RD #20
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1009
Practice Address - Country:US
Practice Address - Phone:561-391-6210
Practice Address - Fax:561-391-2810
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014757500Medicaid