Provider Demographics
NPI:1982789079
Name:NORTH FLORIDA SPECIALISTS IN LUNG DISEASES & INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:NORTH FLORIDA SPECIALISTS IN LUNG DISEASES & INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPHKUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD; FCCP
Authorized Official - Phone:904-824-4532
Mailing Address - Street 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE # 326
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5771
Mailing Address - Country:US
Mailing Address - Phone:904-824-4532
Mailing Address - Fax:904-824-4024
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:SUITE # 326
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5771
Practice Address - Country:US
Practice Address - Phone:904-824-4532
Practice Address - Fax:904-824-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255224800Medicaid
FL255224800Medicaid