MEDICARE: KANSAS N SPARKS DO

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	207Q00000X	Family Medicine Physician	OS14539	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	:	1881073211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANSAS N SPARKS DO

Provider Business Mailing Address
First Line	:	2702 APALACHEE PKWY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3636
Country	:	US
Telephone Number	:	850-755-9252
Fax Number	:	850-546-6278

Provider Business Practice Location Address
First Line	:	2702 APALACHEE PKWY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3636
Country	:	US
Telephone Number	:	850-755-9252
Fax Number	:	850-546-6278

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	04/24/2024

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Directions to “ KANSAS N SPARKS DO” Practice Location

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