Basic Information
| Provider Information | |||||||||
| NPI: | 1023037066 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IVAN ESPAILLAT MD PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440728 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331440728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052551127 | ||||||||
| FaxNumber: | 3052551669 | ||||||||
| Practice Location | |||||||||
| Address1: | 12002 SW 128TH CT | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331864639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052551127 | ||||||||
| FaxNumber: | 3052551669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 09/17/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ESPAILLAT | ||||||||
| AuthorizedOfficialFirstName: | IVAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3052551127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME92158 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.