Provider Demographics
NPI:1316050479
Name:FANDEL, IVAR B (MD)
Entity type:Individual
Prefix:DR
First Name:IVAR
Middle Name:B
Last Name:FANDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-966-6000
Mailing Address - Fax:954-966-3473
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-966-6000
Practice Address - Fax:954-966-3473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0021473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058659500Medicaid
FLD60444Medicare UPIN