Provider Demographics
NPI:1124543608
Name:PERSAUD, KURT KUMAR
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:KUMAR
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 ITHACA CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6752
Mailing Address - Country:US
Mailing Address - Phone:305-684-5147
Mailing Address - Fax:
Practice Address - Street 1:5797 ITHACA CIR E
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6752
Practice Address - Country:US
Practice Address - Phone:305-684-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5226516164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21230000000XMedicaid