Provider Demographics
NPI:1639303829
Name:AL-NASSIR, KALIL IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KALIL
Middle Name:IBRAHIM
Last Name:AL-NASSIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE G02
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4647
Mailing Address - Country:US
Mailing Address - Phone:850-878-8714
Mailing Address - Fax:850-878-2464
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE G02
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4647
Practice Address - Country:US
Practice Address - Phone:850-878-8714
Practice Address - Fax:850-878-2464
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN104508207RC0200X
MN52140207RC0200X
TXP1443207RP1001X
FLME121208207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740535764OtherGROUP NPI
FL1588756944OtherGROUP NPI
TXP1443OtherTEXAS LICENSE
FLME121208OtherFLORIDA LICENSE
FLFA1567049OtherDEA
FLME121208OtherFLORIDA LICENSE
TX1740535764OtherGROUP NPI