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1326003997

NPI Code Detail

MEDICARE: THAD KAMMERLOCHER MD

MEDICARE: THAD KAMMERLOCHER 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	208600000X	Surgery Physician	ME65374	FL
2	2086S0129X	Vascular Surgery Physician	ME65374	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00449663	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260837	OTHER		AVMED
2	7267021	OTHER	FL	AETNA PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2759634	OTHER	FL	CIGNA PROVIDER #
5	46591	OTHER	FL	BCBS PROVIDER #
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326003997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAD KAMMERLOCHER MD

Provider Business Mailing Address
First Line	:	6821 PALISADES PARK CT
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7131
Country	:	US
Telephone Number	:	239-936-8555
Fax Number	:	239-936-5611

Provider Business Practice Location Address
First Line	:	6821 PALISADES PARK CT
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7131
Country	:	US
Telephone Number	:	239-936-8555
Fax Number	:	239-936-5611

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	03/11/2016

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Directions to “ THAD KAMMERLOCHER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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