Provider Demographics
NPI:1770586026
Name:AL-SULEIMAN, OSAMA (MD)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:AL-SULEIMAN
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 1:821 OAKLEY SEAVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1968
Mailing Address - Country:US
Mailing Address - Phone:352-432-7200
Mailing Address - Fax:
Practice Address - Street 1:821 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:352-432-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86774207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7415255OtherCIGNA PROV ID #
FLP00684344OtherMDCRR
FL266607300Medicaid
FL77940OtherMEDICARE GRP
FL57703OtherBCBS OF FL PROV ID #
FLCJ7430OtherMDCRR GRP
FLME86774OtherSTATE MEDICAL LICENSE
FL269859500OtherMEDICAID GRP
FL7841462OtherAETNA PROV ID #
FL269859500OtherMEDICAID GRP
FL7841462OtherAETNA PROV ID #