Basic Information
Provider Information | |||||||||
NPI: | 1902878069 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAMBOUR | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3093 | ||||||||
Address2: |   | ||||||||
City: | BOCA RATON | ||||||||
State: | FL | ||||||||
PostalCode: | 334310993 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055036320 | ||||||||
FaxNumber: | 3055036329 | ||||||||
Practice Location | |||||||||
Address1: | 5000 UNIVERSITY DR | ||||||||
Address2: |   | ||||||||
City: | CORAL GABLES | ||||||||
State: | FL | ||||||||
PostalCode: | 331462008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3056693471 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZC0500X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZD0900X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZF0201X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | 207ZH0000X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZI0100X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | 207ZM0300X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZN0500X | ME35456 | FL | X |   | Allopathic & Osteopathic Physicians | Pathology | Neuropathology |
No ID Information.