Provider Demographics
NPI:1215029731
Name:SINGH, KAUSHALENDRA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAUSHALENDRA
Middle Name:KUMAR
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330196
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-0196
Mailing Address - Country:US
Mailing Address - Phone:386-866-9095
Mailing Address - Fax:877-346-1184
Practice Address - Street 1:205 ZEAGLER DR STE 501
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3887
Practice Address - Country:US
Practice Address - Phone:386-866-9095
Practice Address - Fax:877-346-1184
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049492500Medicaid
K1153Medicare ID - Type Unspecified
07701ZMedicare ID - Type Unspecified
FL049492500Medicaid