1588763924 NPI number — MRS. LINDA KAFOREY P.A.-C.

Table of content: MRS. LINDA KAFOREY P.A.-C. (NPI 1588763924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588763924 NPI number — MRS. LINDA KAFOREY P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAFOREY
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABOU-DIAB
Provider Other First Name:
LINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588763924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16635 2ND AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34212-9634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-225-6939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8927 US HIGHWAY 301 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARRISH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34219-8701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-621-5600
Provider Business Practice Location Address Fax Number:
440-442-5623
Provider Enumeration Date:
09/22/2006

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: 363A00000X , with the licence number:  50-000767 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112927600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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