MEDICARE: R K VISHEN MD P A

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

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	:	1912011511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R K VISHEN MD P A

Provider Business Mailing Address
First Line	:	PO BOX 2310
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32067-2310
Country	:	US
Telephone Number	:	904-388-3351
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 KINGSLEY AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5685
Country	:	US
Telephone Number	:	904-388-3351
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. R. K. VISHEN
Credential	:	MD
Telephone Number	:	904-388-3351

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/04/2013

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