Provider Demographics
NPI:1942500483
Name:DR. NASER KAMKAR M.D. P.A.
Entity Type:Organization
Organization Name:DR. NASER KAMKAR M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-277-9009
Mailing Address - Street 1:3660 CENTRAL AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7699
Mailing Address - Country:US
Mailing Address - Phone:239-277-9009
Mailing Address - Fax:239-277-9007
Practice Address - Street 1:3660 CENTRAL AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7699
Practice Address - Country:US
Practice Address - Phone:239-277-9009
Practice Address - Fax:239-277-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253009100Medicaid
FLE0027AMedicare PIN