Provider Demographics
NPI:1811998842
Name:BOHSALI, KAMAL I (MD)
Entity type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:I
Last Name:BOHSALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 117345
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7345
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-858-6489
Practice Address - Street 1:1577 ROBERTS DR
Practice Address - Street 2:SUITE 225
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3264
Practice Address - Country:US
Practice Address - Phone:904-241-1204
Practice Address - Fax:904-241-7331
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050868207X00000X
FLME95144207X00000X
TXM1028207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016294500Medicaid
FL016294500Medicaid