Provider Demographics
NPI:1053707604
Name:MUFLEH, IZDEAN
Entity type:Individual
Prefix:
First Name:IZDEAN
Middle Name:
Last Name:MUFLEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:561-486-1449
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD STE 305A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7202
Practice Address - Country:US
Practice Address - Phone:561-486-1449
Practice Address - Fax:561-258-6362
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M6824OtherFL MEDICARE