MEDICARE: KAUSHALENDRA K SINGH MD PA

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45411	OTHER	FL	BCBS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780878413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAUSHALENDRA K SINGH MD PA

Provider Business Mailing Address
First Line	:	PO BOX 330196
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-0196
Country	:	US
Telephone Number	:	386-866-9095
Fax Number	:	877-346-1184

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR STE 8
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-3826
Country	:	US
Telephone Number	:	386-866-9095
Fax Number	:	877-346-1184

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SATISH RAVI
Credential	:
Telephone Number	:	386-227-6768

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/12/2024

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