MEDICARE: HARE KRISHNA MEDICAL CARE PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164667879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARE KRISHNA MEDICAL CARE PA

Provider Business Mailing Address
First Line	:	5347 SW 34TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5552
Country	:	US
Telephone Number	:	954-763-6188
Fax Number	:	954-763-6199

Provider Business Practice Location Address
First Line	:	1524 SE 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2502
Country	:	US
Telephone Number	:	954-763-6188
Fax Number	:	954-763-6199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KISHOR O SHETH
Credential	:	M.D.
Telephone Number	:	19173732774

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	06/25/2009

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