Provider Demographics
NPI:1003010679
Name:KAHLON, SUMMERPAL SINGH (MD)
Entity type:Individual
Prefix:
First Name:SUMMERPAL
Middle Name:SINGH
Last Name:KAHLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:SINGH
Other - Last Name:KAHLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 WOODLAND AVE, STE A
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2886
Mailing Address - Country:US
Mailing Address - Phone:321-613-2004
Mailing Address - Fax:321-613-2031
Practice Address - Street 1:30 WOODLAND AVE, STE A
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2886
Practice Address - Country:US
Practice Address - Phone:321-613-2004
Practice Address - Fax:321-613-2031
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101801207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00630689OtherRR MEDICARE
3868063729OtherMYUTMB 3868063729-COMMERCIAL NUMBER
FL41111OtherBCBS
FL8252617OtherCIGNA
FL000106400Medicaid
FLAL468ZMedicare PIN