Provider Demographics
NPI:1497853394
Name:JOSEPH-MCBEAN, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JOSEPH-MCBEAN
Suffix:
Gender:F
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 11457
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1457
Mailing Address - Country:US
Mailing Address - Phone:954-566-7775
Mailing Address - Fax:954-566-9997
Practice Address - Street 1:3465 GALT OCEAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7003
Practice Address - Country:US
Practice Address - Phone:954-566-7775
Practice Address - Fax:954-566-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273628200Medicaid
FL29477ZMedicare ID - Type Unspecified
FL273628200Medicaid