Provider Demographics
NPI:1144206426
Name:ISRAEL, STEVEN LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LAURENCE
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1420 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3025
Mailing Address - Country:US
Mailing Address - Phone:321-837-5123
Mailing Address - Fax:321-837-5129
Practice Address - Street 1:1420 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3025
Practice Address - Country:US
Practice Address - Phone:321-837-5123
Practice Address - Fax:321-837-5129
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL26517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60410Medicare UPIN
FL93281Medicare ID - Type Unspecified