| Gastroenterology Consultants Of Polk County Pa | |
|
40124 Hwy 27 Suite 102 Davenport FL 33837-5905 | |
| (863) 419-1166 | |
| (863) 419-1188 |
| Full Name | Gastroenterology Consultants Of Polk County Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 40124 Hwy 27, Davenport, Florida |
| Authorized Official Name and Position | Jatinder Dhaliwal (MANAGER) |
| Authorized Official Contact | 8634191166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Consultants Of Polk County Pa 40124 Hwy 27 Suite 102 Davenport FL 33837-5905 Ph: (863) 419-1166 | Gastroenterology Consultants Of Polk County Pa 40124 Hwy 27 Suite 102 Davenport FL 33837-5905 Ph: (863) 419-1166 |
| NPI Number | 1205021052 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 04/15/2009 |
| Medicare PECOS PAC ID | 8426198052 |
|---|---|
| Medicare Enrollment ID | O20091212000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205021052 | NPI | - | NPPES |
| 379143200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME0069617 (Florida) | Primary |
| Provider Name | Devendra S Kahlon |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285668897 PECOS PAC ID: 6608916234 Enrollment ID: I20091212000006 |
| Provider Name | Leonel Edwards |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1265453963 PECOS PAC ID: 0446433833 Enrollment ID: I20130612000450 |
| Provider Name | Krista R Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205390630 PECOS PAC ID: 3577803642 Enrollment ID: I20190327002862 |
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