Provider Demographics
NPI:1841252053
Name:BISHAY, ADEL A (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:A
Last Name:BISHAY
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 1:7276 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
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0906922OtherCLIA
FL378763000Medicaid
FLME0068306OtherMEDICAL LICENSE
FLBCBSOther27394
FL378763000Medicaid
FL10D0906922OtherCLIA
FL27394Medicare PIN