Provider Demographics
NPI:1023183092
Name:RILLING, KENT (PAC)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:
Last Name:RILLING
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 MARBLEHEAD LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2336
Mailing Address - Country:US
Mailing Address - Phone:301-922-9166
Mailing Address - Fax:954-405-0501
Practice Address - Street 1:4443 LYONS RD STE 211
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4388
Practice Address - Country:US
Practice Address - Phone:954-405-0501
Practice Address - Fax:954-301-8501
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9109431OtherFL LICENSE
FLMR2071087OtherFL DEA
FLPA9109431OtherFL LICENSE
DCMR0537778OtherDEA REGISTRATION