Healthcare Provider Details

I. General information

NPI: 1396257002
Provider Name (Legal Business Name): KFM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 PASADENA AVE S STE 4G
SOUTH PASADENA FL
33707-4564
US

IV. Provider business mailing address

1609 PASADENA AVE S STE 4G
SOUTH PASADENA FL
33707-4564
US

V. Phone/Fax

Practice location:
  • Phone: 727-323-1090
  • Fax: 727-323-1010
Mailing address:
  • Phone: 727-458-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME89609
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME89609
License Number StateFL

VIII. Authorized Official

Name: DR. KAREN FORSYTHE MONROE
Title or Position: OWNER/ADMINISTRATOR
Credential: MD
Phone: 727-458-5483