Provider Demographics
NPI:1265588750
Name:MOHAMMAD ISMAIL MD INC
Entity type:Organization
Organization Name:MOHAMMAD ISMAIL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-602-2334
Mailing Address - Street 1:16415 COLORADO AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5054
Mailing Address - Country:US
Mailing Address - Phone:562-602-2334
Mailing Address - Fax:562-602-0931
Practice Address - Street 1:16415 COLORADO AVE STE 207
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5054
Practice Address - Country:US
Practice Address - Phone:562-602-2334
Practice Address - Fax:562-602-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045544207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12225Medicare UPIN