| Irene Kardashian M.d. , P.a. | |
|
14100 Fivay Rd Suite 100 Hudson FL 34667-7180 | |
| (727) 819-2534 | |
| (727) 819-2687 |
| Full Name | Irene Kardashian M.d. , P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 14100 Fivay Rd, Hudson, Florida |
| Authorized Official Name and Position | Sharon Larsen (OFFICE MANAGER) |
| Authorized Official Contact | 7278192534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Irene Kardashian M.d. , P.a. 14100 Fivay Rd Suite 100 Hudson FL 34667-7180 Ph: (727) 819-2534 | Irene Kardashian M.d. , P.a. 14100 Fivay Rd Suite 100 Hudson FL 34667-7180 Ph: (727) 819-2534 |
| NPI Number | 1558503367 |
|---|---|
| Provider Enumeration Date | 03/26/2009 |
| Last Update Date | 06/22/2010 |
| Medicare PECOS PAC ID | 6901955970 |
|---|---|
| Medicare Enrollment ID | O20090521000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558503367 | NPI | - | NPPES |
| 1124011804 | Other | FL | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME79368 (Florida) | Primary |
| Provider Name | Irene Kardashian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124011804 PECOS PAC ID: 5395894356 Enrollment ID: I20090521000301 |
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