Provider Demographics
NPI:1174924963
Name:ISLAMAJ, IVAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:ISLAMAJ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 EMBASSY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4573
Mailing Address - Country:US
Mailing Address - Phone:216-502-6577
Mailing Address - Fax:305-701-9902
Practice Address - Street 1:2525 EMBASSY DR STE 5
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4573
Practice Address - Country:US
Practice Address - Phone:888-267-6362
Practice Address - Fax:954-416-6118
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107915363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical