Healthcare Provider Details

I. General information

NPI: 1104989342
Provider Name (Legal Business Name): ISRAEL MACHIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 FOREST HILL BLVD SUITE C
LAKE CLARKE SHORES FL
33406-6077
US

IV. Provider business mailing address

1511 FOREST HILL BLVD SUITE C
LAKE CLARKE SHORES FL
33406-6077
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-3556
  • Fax: 561-967-5559
Mailing address:
  • Phone: 561-433-3556
  • Fax: 561-967-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL MACHIN
Title or Position: OWNER
Credential: MD
Phone: 561-433-3556