Healthcare Provider Details

I. General information

NPI: 1316280886
Provider Name (Legal Business Name): LOUIS F INSALACO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAN BARTOLA DR
ST AUGUSTINE FL
32086-5767
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-8823
  • Fax: 904-808-8587
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number276414
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: