MEDICARE: KADIA MEDICAL, 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	261QP3300X	Pain Clinic/Center
2	261QM2500X	Medical Specialty Clinic/Center

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

General Provider Information

NPI Number	:	1457815474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KADIA MEDICAL, LLC

Provider Business Mailing Address
First Line	:	813 DELTONA BLVD STE A
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7154
Country	:	US
Telephone Number	:	386-507-5269
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 DELTONA BLVD STE A
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7154
Country	:	US
Telephone Number	:	386-507-5269
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. ROBERT E KENT
Credential	:
Telephone Number	:	386-507-5269

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	03/25/2019

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Directions to “KADIA MEDICAL, LLC ” Practice Location

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