Provider Demographics
NPI:1710281340
Name:ISMAEL, HUSSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSAM
Middle Name:
Last Name:ISMAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17222 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-686-2360
Mailing Address - Fax:352-556-4818
Practice Address - Street 1:17222 HOSPITAL BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-686-2360
Practice Address - Fax:352-556-4818
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301097478208600000X
FLME127794208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery