MEDICARE: MICHAEL KASDAGLIS

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	102L00000X	Psychoanalyst	SW10575	FL
2	1041C0700X	Clinical Social Worker	SW10575	FL

General Provider Information

NPI Number	:	1235914987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KASDAGLIS

Provider Business Mailing Address
First Line	:	8855 NW 17TH MNR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6061
Country	:	US
Telephone Number	:	954-344-8352
Fax Number	:	964-287-1556

Provider Business Practice Location Address
First Line	:	8855 NW 17TH MNR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6061
Country	:	US
Telephone Number	:	954-344-8352
Fax Number	:	964-287-1556

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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Directions to “ MICHAEL KASDAGLIS ” Practice Location

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