Basic Information
Provider Information
NPI: 1003010679
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAHLON
FirstName: SUMMER PAL
MiddleName: SINGH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KAHLON
OtherFirstName: SUMMER
OtherMiddleName: SINGH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 200 E SHERIDAN RD
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329013142
CountryCode: US
TelephoneNumber: 3217330663
FaxNumber: 3216766434
Practice Location
Address1: 300 MICHIGAN AVENUE
Address2:  
City: MELBOURNE
State: FL
PostalCode: 32901
CountryCode: US
TelephoneNumber: 3216766322
FaxNumber: 3216766434
Other Information
ProviderEnumerationDate: 06/14/2007
LastUpdateDate: 05/06/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XME101801FLY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
825261701FLCIGNAOTHER
386806372901 MYUTMB 3868063729-COMMERCIAL NUMBEROTHER
P0063068901FLRR MEDICAREOTHER
4111101FLBCBSOTHER
00010640005FL MEDICAID


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