Provider Demographics
NPI:1912095258
Name:ABUSRUR, SADI A (MD)
Entity Type:Individual
Prefix:DR
First Name:SADI
Middle Name:A
Last Name:ABUSRUR
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 1:2240 RICKOVER PL
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5485
Mailing Address - Country:US
Mailing Address - Phone:407-656-6535
Mailing Address - Fax:407-656-6535
Practice Address - Street 1:2116 S ORANGE AVE STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3037
Practice Address - Country:US
Practice Address - Phone:407-704-8990
Practice Address - Fax:407-730-5936
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33741207L00000X, 207LC0200X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038516600Medicaid
D83956Medicare UPIN
FL01266TMedicare ID - Type Unspecified
FL038516600Medicaid