Provider Demographics
NPI:1962453928
Name:KARIA, KISHOR N (MD)
Entity Type:Individual
Prefix:
First Name:KISHOR
Middle Name:N
Last Name:KARIA
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 1:3109 STIRLING ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312
Mailing Address - Country:US
Mailing Address - Phone:954-963-4112
Mailing Address - Fax:954-962-4779
Practice Address - Street 1:3109 STIRLING ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-963-4112
Practice Address - Fax:954-962-4779
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066931800Medicaid
FL066931800Medicaid
D86507Medicare UPIN