=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134147630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONSON, THIRUMALA & ASSOCIATES, MDS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3170 N FEDERAL HWY SUITE # 100C
-----------------------------------------------------
City | LIGHTHOUSE POINT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-785-1104
-----------------------------------------------------
Fax | 954-785-7591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3170 N FEDERAL HWY SUITE # 100C
-----------------------------------------------------
City | LIGHTHOUSE POINT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-785-1104
-----------------------------------------------------
Fax | 954-785-7591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SHAREHOLDER
-----------------------------------------------------
Name | DR. KENNETH J. MONSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-785-1104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------