MEDICARE: KUNNEE CHEW LMT

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	174400000X	Specialist	MA 37050	FL

General Provider Information

NPI Number	:	1922290162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUNNEE CHEW LMT

Provider Business Mailing Address
First Line	:	6500 HIDDEN COVE DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7120
Country	:	US
Telephone Number	:	954-608-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 SHERIDAN ST
Second Line	:	SUITE 6
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2823
Country	:	US
Telephone Number	:	954-608-3017
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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