Provider Demographics
NPI:1275584211
Name:ISMAIL, MUHAMMAD I (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:I
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14315 NW 16TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3001
Mailing Address - Country:US
Mailing Address - Phone:718-308-6886
Mailing Address - Fax:
Practice Address - Street 1:14315 NW 16TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3001
Practice Address - Country:US
Practice Address - Phone:718-308-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME670592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376699300Medicaid
FL376699300Medicaid
FL26354Medicare ID - Type Unspecified