Individual
DR. IVY FASKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3365 BURNS RD, SUITE 206, PALM BEACH GARDENS, FL 33410-4303
(561) 626-4677
(561) 626-6995
Mailing address
11211 PROSPERITY FARMS RD STE A102, PALM BEACH GARDENS, FL 33410-3479
(561) 626-4677
(561) 293-7060
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME 49705
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04337
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/02/2005
Last updated
12/01/2020
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