Healthcare Provider Details

I. General information

NPI: 1679558027
Provider Name (Legal Business Name): GIL YOSIPOVITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 NW 14TH ST
MIAMI FL
33125-1610
US

IV. Provider business mailing address

1295 NW 14TH ST
MIAMI FL
33125-1610
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6704
  • Fax:
Mailing address:
  • Phone: 305-243-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number200500348
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD449759
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMFC1766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: