Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME0076361 | FL |
NPI | 1003820762 |
---|---|
Provider Name | Dr. Kishorkumar N Shukla |
First Address | Orange City, FL 32763-9134 |
Second Address | Orange City, FL 32763-9134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 22/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255838600 | (05) | FL |
F96336 | (02) | FL |