Healthcare Provider Details

I. General information

NPI: 1598383507
Provider Name (Legal Business Name): ROCKET HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WOODLAND AVE STE A
COCOA BEACH FL
32931-2886
US

IV. Provider business mailing address

30 WOODLAND AVENUE STE A
COCOA BEACH FL
32931-2844
US

V. Phone/Fax

Practice location:
  • Phone: 321-613-2004
  • Fax: 321-613-2031
Mailing address:
  • Phone: 321-613-2004
  • Fax: 321-613-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMMERPAL SINGH KAHLON
Title or Position: OWNER
Credential: MD
Phone: 321-613-2004