Provider Demographics
NPI:1720013790
Name:WIZNITZER, ISRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:WIZNITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1723
Mailing Address - Country:US
Mailing Address - Phone:954-432-6595
Mailing Address - Fax:954-324-6266
Practice Address - Street 1:8395 W OAKLAND PARK BLVD
Practice Address - Street 2:STE A
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7301
Practice Address - Country:US
Practice Address - Phone:954-747-6220
Practice Address - Fax:954-747-6228
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84626207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62700OtherBCBS
FL025136300Medicaid
FL62700OtherBCBS
FL265610800Medicaid
FL62700OtherBCBS