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General NPI Number Information
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NPI Number | 1477818375
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Entity Type | Individual
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Provider Name | MELISSA MATZUMURA KUAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2012
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 2441 SURFSIDE BLVD STE 106
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City | CAPE CORAL
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State | FL
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Zip | 33914-3861
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Country | US
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Telephone | 239-424-1687
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Fax | 239-343-4186
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-424-1687
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Fax | 239-343-4186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301101017
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME156758
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License Number State | FL
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