Provider Demographics
NPI:1154149292
Name:ISMAEL, ISMAEL (RRT,RPFT)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:ISMAEL
Suffix:
Gender:M
Credentials:RRT,RPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-1589
Mailing Address - Country:US
Mailing Address - Phone:313-939-7415
Mailing Address - Fax:
Practice Address - Street 1:4028 OLIVER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-1589
Practice Address - Country:US
Practice Address - Phone:313-939-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44010081352279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist