Healthcare Provider Details

I. General information

NPI: 1508165390
Provider Name (Legal Business Name): ISRAEL WOJNOWICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST S STE 350
ST PETERSBURG FL
33701-4732
US

IV. Provider business mailing address

700 6TH ST S
ST PETERSBURG FL
33701-4815
US

V. Phone/Fax

Practice location:
  • Phone: 275-537-4747
  • Fax: 727-553-7472
Mailing address:
  • Phone: 727-893-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: