Provider Demographics
NPI:1093266314
Name:PALM BEACH VASCULAR AND WOUND CARE PA
Entity Type:Organization
Organization Name:PALM BEACH VASCULAR AND WOUND CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-691-1904
Mailing Address - Street 1:1004 S OLD DIXIE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7200
Mailing Address - Country:US
Mailing Address - Phone:561-691-1904
Mailing Address - Fax:
Practice Address - Street 1:1004 S OLD DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7200
Practice Address - Country:US
Practice Address - Phone:561-691-1904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77546207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty