MEDICARE: STEVEN KURUMADA PA

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	363A00000X	Physician Assistant	9111728	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	:	1851867105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN KURUMADA PA

Provider Business Mailing Address
First Line	:	800 TREASURE CAY DR APT 305
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5364
Country	:	US
Telephone Number	:	949-648-6596
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 OKEECHOBEE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5415
Country	:	US
Telephone Number	:	949-648-6596
Fax Number	:

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

Provider Enumeration Date	:	10/14/2018
Last Update Date	:	10/14/2018

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