Healthcare Provider Details

I. General information

NPI: 1821663600
Provider Name (Legal Business Name): TOSCA KINCHELOW MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N UNIVERSITY DR STE 110
PLANTATION FL
33324-2039
US

IV. Provider business mailing address

6919 W BROWARD BLVD # 218
PLANTATION FL
33317-2902
US

V. Phone/Fax

Practice location:
  • Phone: 889-089-0368
  • Fax: 888-259-8701
Mailing address:
  • Phone: 888-908-9036
  • Fax: 888-259-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TOSCA KINCHELOW KULENDRAN
Title or Position: OWNER
Credential: MD
Phone: 888-908-9036