MEDICARE: DR. KAMAL I BOHSALI M.D.

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	207X00000X	Orthopaedic Surgery Physician	050868	GA
2	207X00000X	Orthopaedic Surgery Physician	ME95144	FL
3	207X00000X	Orthopaedic Surgery Physician	M1028	TX

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	:	1811998842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMAL I BOHSALI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 117345
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7345
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-858-6489

Provider Business Practice Location Address
First Line	:	1577 ROBERTS DR
Second Line	:	SUITE 225
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3264
Country	:	US
Telephone Number	:	904-241-1204
Fax Number	:	904-241-7331

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	11/16/2020

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Directions to “ DR. KAMAL I BOHSALI M.D.” Practice Location

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