Provider Demographics
NPI:1831284645
Name:KAFROUNI, ABDALLAH I (MD)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:I
Last Name:KAFROUNI
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 1:4203 BELFORT ROAD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1416
Mailing Address - Country:US
Mailing Address - Phone:904-354-8200
Mailing Address - Fax:904-354-1340
Practice Address - Street 1:4203 BELFORT ROAD
Practice Address - Street 2:SUITE 215
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1416
Practice Address - Country:US
Practice Address - Phone:904-354-8200
Practice Address - Fax:904-354-1340
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38659207R00000X
MDD65843207R00000X
FLME106716207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAPPLIEDMedicaid
MDP00669592OtherR/R MEDICARE PIN
MDCN6601OtherR/R GROUP MEDICARE PIN
KYAPPLIEDMedicare UPIN
KYAPPLIEDMedicare ID - Type Unspecified
MDCN6601OtherR/R GROUP MEDICARE PIN
KYAPPLIEDMedicaid