Healthcare Provider Details

I. General information

NPI: 1932992856
Provider Name (Legal Business Name): ICARE MOBILE WOUND CARE VA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
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 STE PH-1
MIAMI FL
33126-1936
US

V. Phone/Fax

Practice location:
  • Phone: 305-701-9901
  • Fax: 305-701-9902
Mailing address:
  • Phone: 305-701-9901
  • Fax: 305-701-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. IVAN ISLAMAJ
Title or Position: CEO
Credential: P.A.
Phone: 855-247-3627