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NPI Code Detail

MEDICARE: MARK AND KAMBOUR MD PA

MEDICARE: MARK AND KAMBOUR MD PA
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianME60651FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L9100OTHERFLBCBS

General Provider Information

NPI Number : 1447536289
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK AND KAMBOUR MD PA
Provider Business Mailing Address
First Line : PO BOX 100914
Second Line :
City : ATLANTA
State : GA
Zip : 30384-0914
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4665 PONCE DE LEON BLVD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-2101
Country : US
Telephone Number : 305-503-5610
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : ANA VICIANA
Credential : MD
Telephone Number : 305-503-6320
Provider Enumeration Date : 10/25/2011
Last Update Date : 10/25/2011

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