Provider Demographics
NPI:1992247670
Name:TOSCA KINCHELOW MD PA
Entity type:Organization
Organization Name:TOSCA KINCHELOW MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOSCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCHELOW KULENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-908-9036
Mailing Address - Street 1:6919 W BROWARD BLVD # 218
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2902
Mailing Address - Country:US
Mailing Address - Phone:888-908-9036
Mailing Address - Fax:
Practice Address - Street 1:15600 NW 67TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2176
Practice Address - Country:US
Practice Address - Phone:888-908-9036
Practice Address - Fax:888-259-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99415207X00000X, 207XS0106X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AX053OtherMEDICARE