Provider Demographics
NPI:1194138461
Name:CHOCRON KASWAN, ISAAC MARCO (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:MARCO
Last Name:CHOCRON KASWAN
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 1:2100 E HALLANDALE BEACH BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3772
Mailing Address - Country:US
Mailing Address - Phone:954-342-6399
Mailing Address - Fax:
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 403
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3772
Practice Address - Country:US
Practice Address - Phone:954-342-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134813207W00000X, 207W00000X
GA80104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102003600Medicaid