MEDICARE: KEVIN PARKER 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	921189	NY
2	2085R0202X	Diagnostic Radiology Physician	ME121999	FL
3	2085R0202X	Diagnostic Radiology Physician	01089698A	IN
4	2085R0202X	Diagnostic Radiology Physician	EMC0005267	MI
5	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	ME121999	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

General Provider Information

NPI Number	:	1619137106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN PARKER MD

Provider Business Mailing Address
First Line	:	2598 E SUNRISE BLVD STE 2104
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2598 E SUNRISE BLVD STE 2104
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3230
Country	:	US
Telephone Number	:	202-302-4864
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	02/24/2025

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Directions to “ KEVIN PARKER MD” Practice Location

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