MEDICARE: DR. CYGETHIA GAYLE KANKAM 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	207Q00000X	Family Medicine Physician	ME74260	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

General Provider Information

NPI Number	:	1841361144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYGETHIA GAYLE KANKAM M.D

Provider Business Mailing Address
First Line	:	2015 OCEAN DR STE 11
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5131
Country	:	US
Telephone Number	:	561-364-8056
Fax Number	:	561-364-8507

Provider Business Practice Location Address
First Line	:	2015 OCEAN DR STE 11
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5131
Country	:	US
Telephone Number	:	561-364-8056
Fax Number	:	561-364-8507

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	01/05/2023

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