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General NPI Number Information
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NPI Number | 1376217364
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Entity Type | Organization
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Legal Business Name | ISSA.MED P.A.
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 2 PAVILLION PLACE
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City | PENNEY FARMS
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State | FL
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Zip | 32079
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Country | US
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Telephone | 217-416-6431
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 ATLANTIC BLVD STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HANI ISSA
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Credential | M.D.
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Telephone | 217-416-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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