Healthcare Provider Details

I. General information

NPI: 1871731174
Provider Name (Legal Business Name): IVY MAE MUHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 90TH AVE. N. DMI
PINELLAS PARK FL
33782
US

IV. Provider business mailing address

6699 90TH AVE. N. DMI
PINELLAS PARK FL
33782
US

V. Phone/Fax

Practice location:
  • Phone: 727-531-2848
  • Fax:
Mailing address:
  • Phone: 727-531-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: