Healthcare Provider Details

I. General information

NPI: 1376215111
Provider Name (Legal Business Name): ICARE MOBILE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 72ND AVE STE PH-1
MIAMI FL
33126-1936
US

IV. Provider business mailing address

1150 NW 72ND AVE PH 1
MIAMI FL
33126-1920
US

V. Phone/Fax

Practice location:
  • Phone: 786-661-7830
  • Fax: 701-701-9902
Mailing address:
  • Phone: 786-661-7830
  • Fax: 305-701-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVAN ISLAMAJ
Title or Position: PA-C
Credential: PA-C
Phone: 216-502-6577