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General NPI Number Information
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NPI Number | 1396907853
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Entity Type | Organization
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Legal Business Name | LINA KANJ MD PA
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 1936 DAIRY RD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4046
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Country | US
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Telephone | 321-724-1319
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Fax | 321-724-1776
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Provider Business Mailing Address
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Address Line | PO BOX 412017
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City | MELBOURNE
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State | FL
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Zip | 32941-2017
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Country | US
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Telephone | 321-724-1319
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Fax | 321-724-1776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINA KANJ
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Credential | M.D.
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Telephone | 321-724-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME85500
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License Number State | FL
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