Provider Demographics
NPI:1851393599
Name:KAHN, DOUGLAS H (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:H
Last Name:KAHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 SE HILLMOOR DR
Mailing Address - Street 2:STE B
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-335-1200
Mailing Address - Fax:772-335-1292
Practice Address - Street 1:1696 SE HILLMOOR DR # TD
Practice Address - Street 2:STE B
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-335-1200
Practice Address - Fax:772-335-1292
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0002307213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFQ092AOtherMEDICARE PTAN
FL3904130001Medicaid
FL65550YMedicare PIN