Provider Demographics
NPI:1194767210
Name:LABRADOR, ISMAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:LABRADOR
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 1:13985 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7002
Mailing Address - Country:US
Mailing Address - Phone:305-244-2546
Mailing Address - Fax:305-262-5637
Practice Address - Street 1:8506 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4053
Practice Address - Country:US
Practice Address - Phone:305-262-6070
Practice Address - Fax:305-262-5322
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274535600Medicaid
FLI34868Medicare UPIN
FL274535600Medicaid