Provider Demographics
NPI:1922093707
Name:ISMAILI, AGRON (MD)
Entity Type:Individual
Prefix:DR
First Name:AGRON
Middle Name:
Last Name:ISMAILI
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 1:3280 W AUDUBON PARK PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8450
Mailing Address - Country:US
Mailing Address - Phone:352-513-6192
Mailing Address - Fax:352-513-6191
Practice Address - Street 1:3280 W AUDUBON PARK PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8450
Practice Address - Country:US
Practice Address - Phone:352-513-6192
Practice Address - Fax:352-513-6191
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49653-20207R00000X
WI49653208M00000X
IL036144909208M00000X, 207RH0002X, 207R00000X
FLME133180207RH0002X
FLME13380207R00000X
OH35.149413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME133180OtherFLORIDA MEDICAL LICENSE