Provider Demographics
NPI:1104989342
Name:ISRAEL MACHIN MD PA
Entity type:Organization
Organization Name:ISRAEL MACHIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-433-3556
Mailing Address - Street 1:1511 FOREST HILL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6077
Mailing Address - Country:US
Mailing Address - Phone:561-433-3556
Mailing Address - Fax:561-967-5559
Practice Address - Street 1:1511 FOREST HILL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6077
Practice Address - Country:US
Practice Address - Phone:561-433-3556
Practice Address - Fax:561-967-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB648OtherMEDICARE GROUP
FLH78110Medicare UPIN