Provider Demographics
NPI:1932104031
Name:ALRAWI, SADIR JUMAA (MD)
Entity Type:Individual
Prefix:
First Name:SADIR
Middle Name:JUMAA
Last Name:ALRAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7751 BAYMEADOWS RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5834
Practice Address - Country:US
Practice Address - Phone:904-562-4360
Practice Address - Fax:904-645-5856
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227687174400000X
FLME96950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069154200Medicaid
NY02374481Medicaid
FL276592600Medicaid
NYH74563Medicare UPIN
FL069154200Medicaid
FLP00480362Medicare PIN
FL31147ZMedicare PIN