Provider Demographics
NPI:1528022332
Name:BOUKHALIL-LAKLAK, JOSETTE
Entity Type:Individual
Prefix:DR
First Name:JOSETTE
Middle Name:
Last Name:BOUKHALIL-LAKLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSETTE
Other - Middle Name:
Other - Last Name:LAKLAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:8900 N KENDALL DR
Mailing Address - Street 2:EMPLOYEE HEALTH
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2118
Mailing Address - Country:US
Mailing Address - Phone:786-596-6642
Mailing Address - Fax:786-596-0673
Practice Address - Street 1:18430 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6816
Practice Address - Country:US
Practice Address - Phone:305-253-0040
Practice Address - Fax:305-253-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34551200Medicaid
WI000768855Medicare ID - Type Unspecified
WIH22594Medicare UPIN