MEDICARE: VISHWAS S KADAM 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	200402299	MO
2	207R00000X	Internal Medicine Physician	62529	GA

General Provider Information

NPI Number	:	1134221351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHWAS S KADAM MD

Provider Business Mailing Address
First Line	:	1873 EAST MAIN STREET
Second Line	:	STE. B
City	:	HOGANSVILLE
State	:	GA
Zip	:	30230-2756
Country	:	US
Telephone Number	:	706-637-9797
Fax Number	:	706-637-4755

Provider Business Practice Location Address
First Line	:	1873 EAST MAIN STREET
Second Line	:	STE. B
City	:	HOGANSVILLE
State	:	GA
Zip	:	30230-2756
Country	:	US
Telephone Number	:	706-637-9797
Fax Number	:	706-637-4755

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	09/05/2012

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