Provider Demographics
NPI:1861768848
Name:KICHLER, KANDACE MARISA (MD)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:MARISA
Last Name:KICHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 NORTHBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33412-7307
Mailing Address - Country:US
Mailing Address - Phone:561-568-5801
Mailing Address - Fax:
Practice Address - Street 1:1111 LINCOLN RD STE 800
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2451
Practice Address - Country:US
Practice Address - Phone:305-391-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132896208600000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021449500Medicaid