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Individual

KISHORE KUMAR DASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3343 STATE ROAD 7, WELLINGTON, FL 33449-8002
(561) 795-9845
(561) 795-8791
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME63945
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
210526
AVMED
FL
01
23468
BCBS
FL
05
376487700
FL
01
4013
DIMENSION
FL
01
464471
WELLCARE
FL
01
5744141
AETNA
FL
01
P01560757
RR MEDICARE
FL
01
P939537
OPTIMUM
FL
01
P994725
FREEDOM
FL
Enumeration date
10/19/2005
Last updated
10/20/2016
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