Healthcare Provider Details

I. General information

NPI: 1629229646
Provider Name (Legal Business Name): NMC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 LUMSDEN PROFESSIONAL CT
BRANDON FL
33511-5996
US

IV. Provider business mailing address

621 LUMSDEN PROFESSIONAL COURT
BRANDON FL
33511-5996
US

V. Phone/Fax

Practice location:
  • Phone: 813-657-4004
  • Fax:
Mailing address:
  • Phone: 813-574-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY KAHN
Title or Position: PRINCIPAL
Credential: M.D.
Phone: 813-574-1465