# FRED AND LINDA KODESCH, MDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kodesch and Kodesch, MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790937712
- **Authorized official:** FRED KODESCH M.D. (OWNER)
- **Authorized official phone:** (321) 267-2001

## Contact information

- **Practice address:** 4300 GARDEN ST, TITUSVILLE, FL 32796-2937
- **Practice address phone:** (321) 267-2001
- **Practice address fax:** (321) 267-0628
- **Mailing address:** 4300 GARDEN ST, TITUSVILLE, FL 32796-2937
- **Mailing address phone:** (321) 267-2001
- **Mailing address fax:** (321) 267-0628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | ME49057 | FL | — |
| 207W00000X | Ophthalmology Physician | ME49056 | FL | Yes |

## Other

- **Enumeration date:** 10/22/2008
- **Last updated:** 09/27/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 044227500 | — | FL |
| 05 | — | 044369700 | — | FL |