Healthcare Provider Details

I. General information

NPI: 1235624552
Provider Name (Legal Business Name): FARID ISAAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 SE 9TH ST STE 103
FT LAUDERDALE FL
33316-1113
US

IV. Provider business mailing address

407 SE 9TH ST STE 103
FT LAUDERDALE FL
33316-1113
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-0112
  • Fax: 954-463-0117
Mailing address:
  • Phone: 954-463-0112
  • Fax: 954-463-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number161332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: