Provider Demographics
NPI:1821241829
Name:KAHAN PREVENTIVE HEALTHCARE, P.L,
Entity Type:Organization
Organization Name:KAHAN PREVENTIVE HEALTHCARE, P.L,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-968-7830
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261369700Medicaid
C47539Medicare UPIN
FL261369700Medicaid