MEDICARE: KOOLMD.COM CORP.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1821600339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOOLMD.COM CORP.

Provider Business Mailing Address
First Line	:	PO BOX 230610
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89105-0610
Country	:	US
Telephone Number	:	808-783-3666
Fax Number	:	775-855-5853

Provider Business Practice Location Address
First Line	:	4742 LOMAS SANTA FE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6029
Country	:	US
Telephone Number	:	808-783-3666
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KEVIN TEMPLAR
Credential	:	MD
Telephone Number	:	808-783-3666

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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Directions to “KOOLMD.COM CORP. ” Practice Location

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