Provider Demographics
NPI:1457318628
Name:SULTAN, LARNEL P (DO)
Entity Type:Individual
Prefix:
First Name:LARNEL
Middle Name:P
Last Name:SULTAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20615 AMBERFIELD DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4387
Mailing Address - Country:US
Mailing Address - Phone:813-977-0733
Mailing Address - Fax:813-971-2230
Practice Address - Street 1:20615 AMBERFIELD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4301
Practice Address - Country:US
Practice Address - Phone:813-949-2950
Practice Address - Fax:813-949-2924
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H68917Medicare UPIN
51493YMedicare ID - Type Unspecified