MEDICARE: MICHAEL DREW KIGHT P,A.

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	363AM0700X	Medical Physician Assistant	C0003849	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518119361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DREW KIGHT P,A.

Provider Business Mailing Address
First Line	:	PO BOX 61148
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32236-1148
Country	:	US
Telephone Number	:	904-400-6100
Fax Number	:	904-400-6102

Provider Business Practice Location Address
First Line	:	1201 MONUMENT RD
Second Line	:	SUITE 201B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-7411
Country	:	US
Telephone Number	:	904-727-5151
Fax Number	:	904-727-3887

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	12/03/2012

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