Provider Demographics
NPI:1275844870
Name:MOHAMMED, RICARDO KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:KEVIN
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 BERRYHILL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1013
Mailing Address - Country:US
Mailing Address - Phone:850-626-5391
Mailing Address - Fax:
Practice Address - Street 1:5992 BERRYHILL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1013
Practice Address - Country:US
Practice Address - Phone:850-626-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017293208600000X
390200000X
FLOS13830208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA422317Medicare PIN