MEDICARE: GHIATH KASHLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME106343	FL

General Provider Information

NPI Number	:	1053393561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHIATH KASHLAN MD

Provider Business Mailing Address
First Line	:	17921 HUNTING BOW CIR
Second Line	:	SUITE 101
City	:	LUTZ
State	:	FL
Zip	:	33558-5379
Country	:	US
Telephone Number	:	813-792-1900
Fax Number	:	855-287-7006

Provider Business Practice Location Address
First Line	:	8835 HAWBUCK ST
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5361
Country	:	US
Telephone Number	:	813-792-1900
Fax Number	:	855-287-7006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/24/2013

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