1881838340 NPI number — DRAHMANE KABA MD

Table of content: DRAHMANE KABA MD (NPI 1881838340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881838340 NPI number — DRAHMANE KABA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KABA
Provider First Name:
DRAHMANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881838340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5365 W ATLANTIC AVE
Provider Second Line Business Mailing Address:
STE 504
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-8194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-241-9300
Provider Business Mailing Address Fax Number:
561-241-9339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1693 LEE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-622-5766
Provider Business Practice Location Address Fax Number:
407-622-5767
Provider Enumeration Date:
04/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  ME116317 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: ME116317 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: ME116317 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117202300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".