Provider Demographics
NPI:1801032529
Name:ALI, SUMBUL ARSHAD (MD)
Entity Type:Individual
Prefix:
First Name:SUMBUL
Middle Name:ARSHAD
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:14690 SPRING HILL DR STE 206
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-8102
Practice Address - Country:US
Practice Address - Phone:352-799-4206
Practice Address - Fax:352-799-4207
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120964207RE0101X
TXBP10031155390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150LROtherBCBS
FL015120800Medicaid
FL015120800Medicaid
FLIE800ZMedicare PIN
FLIE800YMedicare PIN