Provider Demographics
NPI:1962650028
Name:ISMAIL, IMRAN T (DO)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:T
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-788-5575
Mailing Address - Fax:813-355-5047
Practice Address - Street 1:6606 STADIUM DR STE A
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7510
Practice Address - Country:US
Practice Address - Phone:813-788-5575
Practice Address - Fax:813-355-5047
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPPLIED FOR207R00000X
FLOS10524208M00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDM732TMedicare PIN
FLDM932VMedicare PIN
FLDM932UMedicare PIN