| Dr K Primary Care | |
|
3801 Woodbriar Trl Port Orange FL 32129-9627 | |
| (386) 382-7177 | |
| Not Available |
| Full Name | Dr K Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 3801 Woodbriar Trl, Port Orange, Florida |
| Authorized Official Name and Position | Samira Karakossian (OWNER) |
| Authorized Official Contact | 3863827177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr K Primary Care Po Box 612 New Smyrna Beach FL 32170-0612 Ph: (386) 382-7177 | Dr K Primary Care 3801 Woodbriar Trl Port Orange FL 32129-9627 Ph: (386) 382-7177 |
| NPI Number | 1215689757 |
|---|---|
| Provider Enumeration Date | 01/26/2022 |
| Last Update Date | 06/22/2022 |
| Certification Date | 06/22/2022 |
| Medicare PECOS PAC ID | 8921486358 |
|---|---|
| Medicare Enrollment ID | O20220525002685 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215689757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Samira Karakossian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710114780 PECOS PAC ID: 8921235854 Enrollment ID: I20131220000529 |
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