Provider Demographics
NPI:1093936551
Name:ISAIAH, IFEANYI O (MD)
Entity type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:O
Last Name:ISAIAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17901 NW 5TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-438-8085
Mailing Address - Fax:954-438-8086
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-438-8085
Practice Address - Fax:954-438-8085
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-02-04
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Provider Licenses
StateLicense IDTaxonomies
FLME98154207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 98154OtherMEDICAL LICENSE