Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME101801 | FL |
NPI | 1003010679 |
---|---|
Provider Name | Summerpal Singh Kahlon |
First Address | Cocoa Beach, FL 32931-2886 |
Second Address | Cocoa Beach, FL 32931-2886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000106400 | (05) | FL |
3868063729 | MYUTMB 3868063729-COMMERCIAL NUMBER (01) | |
41111 | BCBS (01) | FL |
8252617 | CIGNA (01) | FL |
P00630689 | RR MEDICARE (01) | FL |