MEDICARE: KAHAN PREVENTIVE HEALTHCARE, P.L,

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	207R00000X	Internal Medicine Physician	ME0047321	FL

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	:	1821241829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAHAN PREVENTIVE HEALTHCARE, P.L,

Provider Business Mailing Address
First Line	:	3661 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2048
Country	:	US
Telephone Number	:	813-968-7830
Fax Number	:	813-265-9697

Provider Business Practice Location Address
First Line	:	3661 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2048
Country	:	US
Telephone Number	:	813-968-7830
Fax Number	:	813-265-9697

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KELLY L KILGORE
Credential	:
Telephone Number	:	813-968-7830

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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