Provider Demographics
NPI:1518217561
Name:SADI A ABUSRUR MD PLLC
Entity Type:Organization
Organization Name:SADI A ABUSRUR MD PLLC
Other - Org Name:SOUTH ORANGE PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SADI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABUSRUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-704-8990
Mailing Address - Street 1:2116 S ORANGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3037
Mailing Address - Country:US
Mailing Address - Phone:407-704-8990
Mailing Address - Fax:407-730-5936
Practice Address - Street 1:2116 S ORANGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3037
Practice Address - Country:US
Practice Address - Phone:407-704-8990
Practice Address - Fax:407-730-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33741207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912095258OtherTYPE 1 NPI