Provider Demographics
NPI:1396257002
Name:KFM MD LLC
Entity type:Organization
Organization Name:KFM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:FORSYTHE
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-458-5483
Mailing Address - Street 1:1609 PASADENA AVE S STE 4G
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4564
Mailing Address - Country:US
Mailing Address - Phone:727-458-5483
Mailing Address - Fax:
Practice Address - Street 1:1609 PASADENA AVE S STE 4G
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4564
Practice Address - Country:US
Practice Address - Phone:727-323-1090
Practice Address - Fax:727-323-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME89609261QP2300X
FLME89609207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty