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General NPI Number Information
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NPI Number | 1982654299
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Entity Type | Organization
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Legal Business Name | ADVENT FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 1447 MEDICAL PARK BLVD 405
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City | WELLINGTON
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State | FL
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Zip | 33414-3164
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Country | US
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Telephone | 561-792-7484
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Fax | 561-792-7454
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Provider Business Mailing Address
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Address Line | 1447 MEDICAL PARK BLVD. 405
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City | WELLINGTON
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State | FL
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Zip | 33414-3164
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Country | US
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Telephone | 561-792-7484
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Fax | 561-792-7454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD K KANKAM
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Credential | D.O.
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Telephone | 561-792-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BK6520806
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License Number State | FL
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