Provider Demographics
NPI:1891256624
Name:PERSAUD, KIA (MBBS)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2021 N MYRTLE POINT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2224
Mailing Address - Country:US
Mailing Address - Phone:843-366-3060
Mailing Address - Fax:843-366-3069
Practice Address - Street 1:2021 N MYRTLE POINT BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2224
Practice Address - Country:US
Practice Address - Phone:843-366-3060
Practice Address - Fax:843-366-3069
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC93036207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology