Provider Demographics
NPI:1992058408
Name:BARROSO, IHOSVANI (MD)
Entity type:Individual
Prefix:
First Name:IHOSVANI
Middle Name:
Last Name:BARROSO
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 1:4835 E 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1814
Mailing Address - Country:US
Mailing Address - Phone:786-899-0119
Mailing Address - Fax:786-899-0440
Practice Address - Street 1:4835 E 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1814
Practice Address - Country:US
Practice Address - Phone:786-899-0119
Practice Address - Fax:786-899-0440
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1223334208000000X, 208000000X
FLME122334208D00000X
PR030246-R282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015241700Medicaid
FLME122334OtherMEDICAL LICENSE