MEDICARE: KAN ANESTHESIA,LLC

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	174400000X	Specialist	ME96802	FL

General Provider Information

NPI Number	:	1215326566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN ANESTHESIA,LLC

Provider Business Mailing Address
First Line	:	3439 PINE RIDGE RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	727-734-6932
Fax Number	:	727-734-4516

Provider Business Practice Location Address
First Line	:	3439 PINE RIDGE RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	727-734-6932
Fax Number	:	727-734-4516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PRATHIMA MOORTHY
Credential	:	M.D.
Telephone Number	:	727-734-6932

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/18/2016

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