Healthcare Provider Details

I. General information

NPI: 1750004792
Provider Name (Legal Business Name): KAISER DYNAMIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E DANIA BEACH BLVD UNIT 1202
DANIA BEACH FL
33004-3004
US

IV. Provider business mailing address

7909 FAITH LN
MONTGOMERY AL
36117-3752
US

V. Phone/Fax

Practice location:
  • Phone: 404-910-6089
  • Fax:
Mailing address:
  • Phone: 404-910-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE I CRAWFORD
Title or Position: CMO
Credential: MD
Phone: 404-910-6098