Provider Demographics
NPI:1215139712
Name:IVO ALONSO MD PA
Entity type:Organization
Organization Name:IVO ALONSO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:IVO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-7499
Mailing Address - Street 1:3934 SW 8TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:305-448-7499
Mailing Address - Fax:305-448-5061
Practice Address - Street 1:3934 SW 8TH ST STE 207
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:305-448-7499
Practice Address - Fax:305-448-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82269208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FMH46685Medicare UPIN