Individual
ILKHOM SULEYMANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204-4748
(904) 308-7300
Mailing address
4008 LAURELWOOD DR, JACKSONVILLE, FL 32257-8912
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W251704381
AETNA
FL
Enumeration date
05/26/2019
Last updated
05/26/2019
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