MEDICARE: SHEEJA A KANACHERIL D.O.

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	207Q00000X	Family Medicine Physician	OS10092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	46017	OTHER	FL	BLUE CROSS
3	325319	OTHER	FL	AETNA
4	390683	OTHER	FL	WELLCARE
5	325319	OTHER	FL	AMERIGROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275756603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEEJA A KANACHERIL D.O.

Provider Business Mailing Address
First Line	:	1530 LEE BLVD
Second Line	:	SUITE 1100
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4893
Country	:	US
Telephone Number	:	239-368-0241
Fax Number	:	239-368-0398

Provider Business Practice Location Address
First Line	:	1530 LEE BLVD
Second Line	:	SUITE 1100
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4893
Country	:	US
Telephone Number	:	239-368-0241
Fax Number	:	239-368-0398

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/12/2013

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Directions to “ SHEEJA A KANACHERIL D.O.” Practice Location

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