MEDICARE: DR. KATHRYN DIANA CONVERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	ME124960	FL

General Provider Information

NPI Number	:	1043417769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN DIANA CONVERS M.D.

Provider Business Mailing Address
First Line	:	4325 HIGHLAND PARK BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1671
Country	:	US
Telephone Number	:	863-213-1010
Fax Number	:	813-661-3227

Provider Business Practice Location Address
First Line	:	4325 HIGHLAND PARK BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1671
Country	:	US
Telephone Number	:	863-213-1010
Fax Number	:	863-213-1020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	04/09/2024

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