MEDICARE: KISKEYA HEALTH NETWORK LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1457550675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISKEYA HEALTH NETWORK LLC

Provider Business Mailing Address
First Line	:	126 N FLAGLER AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6635
Country	:	US
Telephone Number	:	954-942-7500
Fax Number	:	954-942-7795

Provider Business Practice Location Address
First Line	:	126 N FLAGLER AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6635
Country	:	US
Telephone Number	:	954-942-7500
Fax Number	:	954-942-7795

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YANIQUE DUVAL
Credential	:	M.D
Telephone Number	:	561-687-1304

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	10/02/2008

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