Provider Demographics
NPI:1700472420
Name:KMD MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:KMD MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-901-1741
Mailing Address - Street 1:1800 NE 114TH ST APT 2001
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3413
Mailing Address - Country:US
Mailing Address - Phone:561-901-1741
Mailing Address - Fax:
Practice Address - Street 1:1800 NE 114TH ST APT 2001
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3413
Practice Address - Country:US
Practice Address - Phone:561-901-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty