Provider Demographics
NPI:1427073329
Name:PENATE, ISRAEL E (MD)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:E
Last Name:PENATE
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 1:9800 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4039
Mailing Address - Country:US
Mailing Address - Phone:954-755-5504
Mailing Address - Fax:954-755-7052
Practice Address - Street 1:9800 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4039
Practice Address - Country:US
Practice Address - Phone:954-755-5504
Practice Address - Fax:954-755-7052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94617207R00000X
FLME94617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB591ZMedicare PIN
FLAB591YMedicare PIN
FLI70348Medicare UPIN