Provider Demographics
NPI:1558359802
Name:FAWZI SOLIMAN MD PA
Entity Type:Organization
Organization Name:FAWZI SOLIMAN MD PA
Other - Org Name:GULF COAST SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-596-0744
Mailing Address - Street 1:12132 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5575
Mailing Address - Country:US
Mailing Address - Phone:352-596-0744
Mailing Address - Fax:352-596-5401
Practice Address - Street 1:12132 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5575
Practice Address - Country:US
Practice Address - Phone:352-596-0744
Practice Address - Fax:352-596-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA5477OtherRR MEDICARE
FL063495600Medicaid
FLCA5477OtherRR MEDICARE
FL97811Medicare PIN