Provider Demographics
NPI:1396981635
Name:PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC
Entity type:Organization
Organization Name:PASADENA CENTER FOR ASTHMA & LUNG DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:ALI ELTOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-347-5242
Mailing Address - Street 1:5454 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6129
Mailing Address - Country:US
Mailing Address - Phone:727-347-5242
Mailing Address - Fax:727-347-2402
Practice Address - Street 1:5454 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6129
Practice Address - Country:US
Practice Address - Phone:727-347-5242
Practice Address - Fax:727-347-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100366207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN978180300Medicaid
I12393Medicare UPIN