Provider Demographics
NPI:1295026243
Name:RAPADO, IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:RAPADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IVAN
Other - Middle Name:
Other - Last Name:RAPADO VIERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1200 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3810
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:448-742-6552
Practice Address - Street 1:10980 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6615
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-592-2597
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005475100Medicaid
FL005475100Medicaid