Provider Demographics
NPI:1619918141
Name:HOSSAIN, ISMAT (MD)
Entity Type:Individual
Prefix:
First Name:ISMAT
Middle Name:
Last Name:HOSSAIN
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 1:3898 VIA POINCIANA
Mailing Address - Street 2:STE 19
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2951
Mailing Address - Country:US
Mailing Address - Phone:561-619-6480
Mailing Address - Fax:561-619-6418
Practice Address - Street 1:3898 VIA POINCIANA
Practice Address - Street 2:SUITE 19
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2951
Practice Address - Country:US
Practice Address - Phone:561-619-6480
Practice Address - Fax:561-619-6418
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271600300Medicaid
FL271600300Medicaid