Healthcare Provider Details

I. General information

NPI: 1285668897
Provider Name (Legal Business Name): DEVENDRA S KAHLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40124N US 27 SUITE 102
DAVENPORT FL
33837
US

IV. Provider business mailing address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-1166
  • Fax: 863-419-1188
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0069617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: