MEDICARE: GASTROENTEROLOGY ASSOCIATES OF THE TREASURE COAST, P.A.

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	174400000X	Specialist	37070	FL

General Provider Information

NPI Number	:	1629250428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES OF THE TREASURE COAST, P.A.

Provider Business Mailing Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:	SUITE 402
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-335-7883
Fax Number	:	772-335-3143

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:	SUITE 402
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-335-7883
Fax Number	:	772-335-3143

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH RALPH KOHEN
Credential	:	M.D.
Telephone Number	:	772-335-7883

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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