Provider Demographics
NPI:1629398441
Name:ISSAC, LAILAH (DO)
Entity Type:Individual
Prefix:
First Name:LAILAH
Middle Name:
Last Name:ISSAC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4317
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:RM 1433
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7722
Practice Address - Country:US
Practice Address - Phone:954-262-5590
Practice Address - Fax:954-262-5570
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS147442081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine