Provider Demographics
NPI:1164667879
Name:HARE KRISHNA MEDICAL CARE PA
Entity Type:Organization
Organization Name:HARE KRISHNA MEDICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1917-373-2774
Mailing Address - Street 1:5347 SW 34TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5552
Mailing Address - Country:US
Mailing Address - Phone:954-763-6188
Mailing Address - Fax:954-763-6199
Practice Address - Street 1:1524 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2502
Practice Address - Country:US
Practice Address - Phone:954-763-6188
Practice Address - Fax:954-763-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty