Provider Demographics
NPI:1063910800
Name:JOSETTE BOUKHALIL-LAKLAK MD PA
Entity type:Organization
Organization Name:JOSETTE BOUKHALIL-LAKLAK MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUKHALIL-LAKLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-253-0040
Mailing Address - Street 1:18430 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6816
Mailing Address - Country:US
Mailing Address - Phone:305-253-0123
Mailing Address - Fax:305-253-0177
Practice Address - Street 1:18430 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6816
Practice Address - Country:US
Practice Address - Phone:305-253-0123
Practice Address - Fax:305-253-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0097334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty