MEDICARE: MRS. SOWMYA IYER KISHOR M.D.

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	207N00000X	Dermatology Physician	ME102622	FL
2	207N00000X	Dermatology Physician	ME 102622	FL

General Provider Information

NPI Number	:	1326288721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOWMYA IYER KISHOR M.D.

Provider Business Mailing Address
First Line	:	143 VIERA DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1741
Country	:	US
Telephone Number	:	757-218-1597
Fax Number	:

Provider Business Practice Location Address
First Line	:	4475 MEDICAL CENTER WAY
Second Line	:	SUITE 2
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3240
Country	:	US
Telephone Number	:	561-863-1000
Fax Number	:

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	03/29/2021

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