Provider Demographics
NPI:1447678438
Name:ASIF KAMAL MD PA
Entity type:Organization
Organization Name:ASIF KAMAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-889-7440
Mailing Address - Street 1:21202 OLEAN BLVD STE C6
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6771
Mailing Address - Country:US
Mailing Address - Phone:941-889-7440
Mailing Address - Fax:941-391-6089
Practice Address - Street 1:21202 OLEAN BLVD STE C6
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6771
Practice Address - Country:US
Practice Address - Phone:941-889-7440
Practice Address - Fax:941-391-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME71572OtherSTATE LICENSE