MEDICARE: KAN-DI-KI LLC

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	2085U0001X	Diagnostic Ultrasound Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01068298	OTHER		RAILROAD MEDICARE

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	:	1871898841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN-DI-KI LLC

Provider Business Mailing Address
First Line	:	930 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9481
Country	:	US
Telephone Number	:	7-868-0188
Fax Number	:	410-472-1754

Provider Business Practice Location Address
First Line	:	11585 E 53RD AVE STE H
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-2321
Country	:	US
Telephone Number	:	303-307-2028
Fax Number	:	443-842-7264

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/CFO
Name	:	BRIAN C CUOMO
Credential	:
Telephone Number	:	800-786-8015

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	02/12/2024

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Directions to “KAN-DI-KI LLC ” Practice Location

Language	Start Address	Practice Location

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