Provider Demographics
NPI:1396952446
Name:SOLIMAN, FAWZI (MD,PA)
Entity type:Individual
Prefix:DR
First Name:FAWZI
Middle Name:
Last Name:SOLIMAN
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 CORTEZ BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5411
Mailing Address - Country:US
Mailing Address - Phone:352-596-0744
Mailing Address - Fax:352-596-5401
Practice Address - Street 1:11373 CORTEZ BLVD STE 301
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5411
Practice Address - Country:US
Practice Address - Phone:352-596-0744
Practice Address - Fax:352-596-5401
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00396432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069030900Medicaid
FL330000255OtherRR MEDICARE