MEDICARE: DR. KENNETH IYAMU M.D

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	ME0090707	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922104835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH IYAMU M.D

Provider Business Mailing Address
First Line	:	1700 N MCMULLEN BOOTH RD
Second Line	:	D1
City	:	CLEARWATER
State	:	FL
Zip	:	33759-2130
Country	:	US
Telephone Number	:	727-669-3800
Fax Number	:	727-669-5600

Provider Business Practice Location Address
First Line	:	1700 N MCMULLEN BOOTH RD
Second Line	:	D1
City	:	CLEARWATER
State	:	FL
Zip	:	33759-2130
Country	:	US
Telephone Number	:	727-669-3800
Fax Number	:	727-669-5600

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	09/12/2013

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Directions to “ DR. KENNETH IYAMU M.D” Practice Location

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