MEDICARE: DR. FEDERICO KALLMANN CRUZ MD

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	207R00000X	Internal Medicine Physician	ME78937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49425	OTHER	FL	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447253414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FEDERICO KALLMANN CRUZ MD

Provider Business Mailing Address
First Line	:	8400 NW 33RD ST
Second Line	:	101
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5713
Country	:	US
Telephone Number	:	844-665-4827
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/31/2016

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