MEDICARE: JONATHAN KUDROWITZ PA-C

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	363A00000X	Physician Assistant	PA9105136	FL

General Provider Information

NPI Number	:	1265761548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KUDROWITZ PA-C

Provider Business Mailing Address
First Line	:	6385 SWEET MAPLE LN
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-1934
Country	:	US
Telephone Number	:	561-289-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	6931 W BROWARD BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2902
Country	:	US
Telephone Number	:	954-321-5191
Fax Number	:	954-321-5192

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

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	12/15/2009

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