MEDICARE: K. SYLVARA FAMILY PRACTICE, L.L.C

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	101191	MS

General Provider Information

NPI Number	:	1770897977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. SYLVARA FAMILY PRACTICE, L.L.C

Provider Business Mailing Address
First Line	:	502 S BALTIMORE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-3728
Country	:	US
Telephone Number	:	660-665-5570
Fax Number	:	660-665-2898

Provider Business Practice Location Address
First Line	:	502 S BALTIMORE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-3728
Country	:	US
Telephone Number	:	660-665-5570
Fax Number	:	660-665-2898

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAREN A SYLVARA
Credential	:	D.O.
Telephone Number	:	660-665-5570

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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