Individual
DR. IZAK KIELMOVITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
133 BENMORE DR, STE 100, WINTER PARK, FL 32792-4143
(407) 644-4883
(407) 644-3697
Mailing address
133 BENMORE DR, STE 100, WINTER PARK, FL 32792-4143
(407) 644-4883
(407) 644-3697
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME59630
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01106345
AMERIGROUP
—
01
—
040006660
RR MEDICARE
—
01
—
040006661
RR MEDICARE
—
05
—
054553800
—
FL
01
—
12335
BLUE CROSS
—
01
—
ME0059630
WORKER'S COMP
—
Enumeration date
06/01/2005
Last updated
05/07/2015
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