Provider Demographics
NPI:1053579037
Name:TCHABAN, ISRAEL JONATHAN (MD, SA)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:JONATHAN
Last Name:TCHABAN
Suffix:
Gender:M
Credentials:MD, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18061 BISCAYNE BLVD APT 1901
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5278
Mailing Address - Country:US
Mailing Address - Phone:786-417-7973
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-823-9120
Practice Address - Fax:305-824-8839
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL08-121363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical