Healthcare Provider Details

I. General information

NPI: 1114960481
Provider Name (Legal Business Name): ALAN HOWARD ITZKOWITZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

11365 NW 18TH ST
PLANTATION FL
33323-2225
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6448
  • Fax:
Mailing address:
  • Phone: 954-476-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS8565
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0S 8565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: