Provider Demographics
NPI:1942419379
Name:ADEL A BISHAY MD PA
Entity Type:Organization
Organization Name:ADEL A BISHAY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BISHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-796-4903
Mailing Address - Street 1:7276 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-5591
Mailing Address - Country:US
Mailing Address - Phone:352-796-4903
Mailing Address - Fax:352-796-2144
Practice Address - Street 1:7276 BROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-5591
Practice Address - Country:US
Practice Address - Phone:352-796-4903
Practice Address - Fax:352-796-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068306208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378736000Medicaid
FL27394OtherBCBS
FL378736000Medicaid
FLG16384Medicare UPIN
FL378736000Medicaid