Healthcare Provider Details

I. General information

NPI: 1689168734
Provider Name (Legal Business Name): TUNC CAN KIYMAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LAKEMONT AVE STE 207
WINTER PARK FL
32792-3219
US

IV. Provider business mailing address

833 CHESTNUT ST STE 520
PHILADELPHIA PA
19107-4430
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-4070
  • Fax: 407-743-3050
Mailing address:
  • Phone: 267-339-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME165495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: