MEDICARE: ISMAT HOSSAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME90926	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619918141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAT HOSSAIN M.D.

Provider Business Mailing Address
First Line	:	3898 VIA POINCIANA
Second Line	:	STE 19
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2951
Country	:	US
Telephone Number	:	561-619-6480
Fax Number	:	561-619-6418

Provider Business Practice Location Address
First Line	:	3898 VIA POINCIANA
Second Line	:	SUITE 19
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2951
Country	:	US
Telephone Number	:	561-619-6480
Fax Number	:	561-619-6418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/30/2016

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