Provider Demographics
NPI:1447211156
Name:KAHAN, BRUCE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:KAHAN
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 1:3661 MADACA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2048
Mailing Address - Country:US
Mailing Address - Phone:813-968-7830
Mailing Address - Fax:813-265-9697
Practice Address - Street 1:3661 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2048
Practice Address - Country:US
Practice Address - Phone:813-968-7830
Practice Address - Fax:813-265-9697
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02483OtherBLUE CROSS BLUE SHIELD
1467046OtherCIGNA PROVIDER NO
0481019OtherUNITED PROVIDER NO
FL261369700Medicaid
4045797OtherAETNA PROVIDER NO
0481019OtherUNITED PROVIDER NO
FLC47539Medicare UPIN