Provider Demographics
NPI:1679560122
Name:ISRAEL-CVIK, JELIN N (MD)
Entity Type:Individual
Prefix:
First Name:JELIN
Middle Name:N
Last Name:ISRAEL-CVIK
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 1:5248 RED CEDAR DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4522
Mailing Address - Country:US
Mailing Address - Phone:239-936-7171
Mailing Address - Fax:239-936-7455
Practice Address - Street 1:5248 RED CEDAR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4522
Practice Address - Country:US
Practice Address - Phone:239-936-7171
Practice Address - Fax:239-936-7455
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0087520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine