Provider Demographics
NPI:1306876644
Name:DOUGLAS H. KAHN, DPM, PA
Entity type:Organization
Organization Name:DOUGLAS H. KAHN, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-213-3757
Mailing Address - Street 1:12180 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1820
Mailing Address - Country:US
Mailing Address - Phone:727-572-5449
Mailing Address - Fax:727-573-2048
Practice Address - Street 1:1114 EAST DUVAL STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-752-7813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2703213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU70689Medicare UPIN
FL65550CMedicare ID - Type Unspecified