Provider Demographics
NPI:1508010695
Name:SUHAIL A.MASUDI, M.D, PA
Entity Type:Organization
Organization Name:SUHAIL A.MASUDI, M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-586-0881
Mailing Address - Street 1:10111 W FOREST HILL BLVD
Mailing Address - Street 2:STE. # 268
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-586-0881
Mailing Address - Fax:561-586-0166
Practice Address - Street 1:10111 W FOREST HILL BLVD
Practice Address - Street 2:STE. # 268
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-586-0881
Practice Address - Fax:561-586-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86182207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty