Basic Information
| Provider Information | |||||||||
| NPI: | 1679560122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISRAEL-CVIK | ||||||||
| FirstName: | JELIN | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5248 RED CEDAR DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339074522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399367171 | ||||||||
| FaxNumber: | 2399367455 | ||||||||
| Practice Location | |||||||||
| Address1: | 5248 RED CEDAR DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339074522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399367171 | ||||||||
| FaxNumber: | 2399367455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0087520 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.