MEDICARE: DR. KAMLESH C DAVE 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	207Q00000X	Family Medicine Physician	34317	KY

General Provider Information

NPI Number	:	1679599500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMLESH C DAVE MD

Provider Business Mailing Address
First Line	:	PO BOX 473
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-0473
Country	:	US
Telephone Number	:	502-693-2465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 NEW MOODY LN
Second Line	:
City	:	LAGRANGE
State	:	KY
Zip	:	40031-9122
Country	:	US
Telephone Number	:	502-222-0028
Fax Number	:	502-222-0029

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/07/2010

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