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General NPI Number Information
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NPI Number | 1558345173
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Entity Type | Organization
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Legal Business Name | KISSIMMEE MEDICAL CENTER PA
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 1910 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4301
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Country | US
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Telephone | 407-343-4338
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Fax | 407-343-4335
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Provider Business Mailing Address
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Address Line | 1910 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4301
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Country | US
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Telephone | 407-343-4338
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Fax | 407-343-4335
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANTI SINGH
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Credential | MD
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Telephone | 407-343-4338
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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 |
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License Number State |
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