MEDICARE: DR. KRISTEN L PAULUS 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	208000000X	Pediatrics Physician	ME73853	FL
2	207R00000X	Internal Medicine Physician	ME73853	FL

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
2	42492	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1639168628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN L PAULUS MD

Provider Business Mailing Address
First Line	:	PO BOX 863407
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-3407
Country	:	US
Telephone Number	:	941-917-2600
Fax Number	:	941-917-7884

Provider Business Practice Location Address
First Line	:	5880 RAND BLVD STE 200
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-5118
Country	:	US
Telephone Number	:	941-917-2300
Fax Number	:	941-923-1453

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/09/2020

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