Provider Demographics
NPI:1275944134
Name:DR ISAREL MACHIN
Entity Type:Organization
Organization Name:DR ISAREL MACHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-451-5784
Mailing Address - Street 1:1511 FOREST HILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6077
Mailing Address - Country:US
Mailing Address - Phone:561-433-3556
Mailing Address - Fax:
Practice Address - Street 1:1511 FOREST HILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE
Practice Address - State:FL
Practice Address - Zip Code:33406-6077
Practice Address - Country:US
Practice Address - Phone:561-433-3556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site