Provider Demographics
NPI:1245229533
Name:DASS, KISHORE KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:KISHORE
Middle Name:KUMAR
Last Name:DASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3343 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8002
Practice Address - Country:US
Practice Address - Phone:561-795-9845
Practice Address - Fax:561-795-8791
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME639452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23468OtherBCBS
FL210526OtherAVMED
FL464471OtherWELLCARE
FL5744141OtherAETNA
FL376487700Medicaid
FLP01560757OtherRR MEDICARE
FLP994725OtherFREEDOM
FL4013OtherDIMENSION
FLP939537OtherOPTIMUM
FL5744141OtherAETNA
FLP994725OtherFREEDOM
FL23468SMedicare PIN