Provider Demographics
NPI:1598734154
Name:IONESCU, MIHAELA (MD)
Entity Type:Individual
Prefix:
First Name:MIHAELA
Middle Name:
Last Name:IONESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 KINGSLEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5128
Mailing Address - Country:US
Mailing Address - Phone:904-298-2113
Mailing Address - Fax:904-298-1922
Practice Address - Street 1:1536 KINGSLEY AVE STE 118
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4525
Practice Address - Country:US
Practice Address - Phone:904-298-2113
Practice Address - Fax:904-298-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79995207RI0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258902800Medicaid
FLG59835Medicare UPIN