Provider Demographics
NPI:1841468279
Name:AGATSTEIN, IRA J (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:J
Last Name:AGATSTEIN
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 1:6140 SW 70TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3419
Mailing Address - Country:US
Mailing Address - Phone:954-476-7933
Mailing Address - Fax:
Practice Address - Street 1:6140 SW 70TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3419
Practice Address - Country:US
Practice Address - Phone:954-476-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine