Provider Demographics
NPI:1366962979
Name:DOLCINE, KANOULD (MD)
Entity type:Individual
Prefix:DR
First Name:KANOULD
Middle Name:
Last Name:DOLCINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KANOULD
Other - Middle Name:
Other - Last Name:DOLCINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:601 N CONGRESS AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4639
Mailing Address - Country:US
Mailing Address - Phone:561-272-7714
Mailing Address - Fax:
Practice Address - Street 1:601 N CONGRESS AVE STE 404
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4639
Practice Address - Country:US
Practice Address - Phone:561-272-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
08439994OtherECFMG (USMLE)
FL102551600Medicaid