Provider Demographics
NPI:1942263876
Name:LITZENBLATT, IRA M (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:M
Last Name:LITZENBLATT
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 1:4701 N FEDERAL HWY
Mailing Address - Street 2:SUITE A-10
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4608
Mailing Address - Country:US
Mailing Address - Phone:954-351-1100
Mailing Address - Fax:954-351-1197
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE A-10
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-351-1100
Practice Address - Fax:954-351-1197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 36265207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93808AMedicare ID - Type Unspecified
FLD63015Medicare UPIN