Provider Demographics
NPI:1689817918
Name:EMMED, P.A.
Entity Type:Organization
Organization Name:EMMED, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEGRAAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-359-3779
Mailing Address - Street 1:PO BOX 7059
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-7059
Mailing Address - Country:US
Mailing Address - Phone:727-359-3779
Mailing Address - Fax:727-862-5455
Practice Address - Street 1:120 MEDICAL BLVD
Practice Address - Street 2:STE #106
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0220
Practice Address - Country:US
Practice Address - Phone:727-359-3779
Practice Address - Fax:352-684-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty