Healthcare Provider Details

I. General information

NPI: 1457815474
Provider Name (Legal Business Name): KADIA MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 DELTONA BLVD STE A
DELTONA FL
32725-7154
US

IV. Provider business mailing address

813 DELTONA BLVD STE A
DELTONA FL
32725-7154
US

V. Phone/Fax

Practice location:
  • Phone: 386-507-5269
  • Fax:
Mailing address:
  • Phone: 386-507-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT E KENT
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 386-507-5269