Provider Demographics
NPI:1801168281
Name:MANHART, ISIS FLAVIA (MD)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:FLAVIA
Last Name:MANHART
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 1:1094 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7021
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:
Practice Address - Street 1:1094 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:616-226-1115
Practice Address - Fax:855-215-9930
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024240900Medicaid