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NPI Code Detail

MEDICARE: ROBERT KAWA D.O.

MEDICARE:   ROBERT  KAWA  D.O.
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
1207Q00000XFamily Medicine PhysicianUO 3902FL
2207Q00000XFamily Medicine PhysicianOS13849FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750794616
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT KAWA D.O.
Provider Business Mailing Address
First Line : 282 SENTOSA DR UNIT 102
Second Line :
City : SAINT JOHNS
State : FL
Zip : 32259-9196
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 COLONNADE DR STE 160
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-6236
Country : US
Telephone Number : 904-824-1020
Fax Number : 904-824-5333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2014
Last Update Date : 08/19/2021

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