Provider Demographics
NPI:1316338551
Name:IMMINENT SURGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:IMMINENT SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:ZIAD
Authorized Official - Last Name:AL-RAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-404-6211
Mailing Address - Street 1:PO BOX 15365
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1365
Mailing Address - Country:US
Mailing Address - Phone:941-404-6211
Mailing Address - Fax:877-274-4518
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-404-6211
Practice Address - Fax:877-274-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113621208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014458600Medicaid