Provider Demographics
NPI:1316081318
Name:ISSAR, REKHA (MD)
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:ISSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 S FLORIDA AVE
Mailing Address - Street 2:SUITE # A1
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1105
Mailing Address - Country:US
Mailing Address - Phone:863-619-5100
Mailing Address - Fax:863-619-5102
Practice Address - Street 1:3810 S FLORIDA AVE
Practice Address - Street 2:SUIR # A1
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1105
Practice Address - Country:US
Practice Address - Phone:863-619-5100
Practice Address - Fax:863-619-5102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266339200Medicaid
FLH29656Medicare UPIN
FLK4399Medicare ID - Type Unspecified