MEDICARE: KEVIN ANDRE FUNK 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	207P00000X	Emergency Medicine Physician	J3473	TX
2	207Q00000X	Family Medicine Physician	J3473	TX
3	207Q00000X	Family Medicine Physician	ME144992	FL

General Provider Information

NPI Number	:	1619938644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ANDRE FUNK M.D.

Provider Business Mailing Address
First Line	:	6100 SAINT JOHNS AVE STE 5
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-6859
Country	:	US
Telephone Number	:	386-530-5640
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 SAINT JOHNS AVE STE 5
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-6859
Country	:	US
Telephone Number	:	386-530-5640
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	08/01/2024

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Directions to “ KEVIN ANDRE FUNK M.D.” Practice Location

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