Provider Demographics
NPI:1750585758
Name:NORTH PULASKI UROLOGY PL
Entity type:Organization
Organization Name:NORTH PULASKI UROLOGY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-912-9292
Mailing Address - Street 1:2215 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5089
Mailing Address - Country:US
Mailing Address - Phone:501-912-9292
Mailing Address - Fax:501-552-7593
Practice Address - Street 1:2215 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72120-5089
Practice Address - Country:US
Practice Address - Phone:501-912-9292
Practice Address - Fax:501-552-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4551208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C889Medicare ID - Type Unspecified
ARB90605Medicare UPIN