Provider Demographics
NPI:1306839980
Name:ALONSO, IVO (MD)
Entity Type:Individual
Prefix:
First Name:IVO
Middle Name:
Last Name:ALONSO
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 1:3934 SW 8TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:305-448-7499
Mailing Address - Fax:305-448-5061
Practice Address - Street 1:3934 SW 8TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:305-448-7499
Practice Address - Fax:305-448-5061
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82269208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258068302Medicaid
FLE5977BMedicare ID - Type Unspecified
FL258068302Medicaid