Provider Demographics
NPI:1598299802
Name:MANRAJ, KEVAN
Entity Type:Individual
Prefix:
First Name:KEVAN
Middle Name:
Last Name:MANRAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 SOUTH SEACREST BLVD., SUITE 100
Mailing Address - Street 2:FLORIDA ATLANTIC UNIVERSITY INTERNAL MEDICINE RESIDENCY
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-735-6553
Mailing Address - Fax:561-735-7739
Practice Address - Street 1:1825 PALM COVE BLVD APT 302
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6780
Practice Address - Country:US
Practice Address - Phone:203-819-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME144383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program