MEDICARE: KAHP S SO 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	21950	IA

General Provider Information

NPI Number	:	1871578773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAHP S SO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2910
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50704-2910
Country	:	US
Telephone Number	:	319-233-3044
Fax Number	:	319-233-0722

Provider Business Practice Location Address
First Line	:	3421 W 9TH ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5401
Country	:	US
Telephone Number	:	319-272-8000
Fax Number	:	319-233-0722

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/26/2007

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Directions to “ KAHP S SO M.D.” Practice Location

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