| Organization Name: | KABS GOODWILL, LLC |
| NPI Number: | 1225354822 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BODE ISHOLA (PRESIDENT) |
| Mailing Address: | 2806 E Bearss Ave Tampa |
| State: | FL US |
| Postal Code: | 336132653 |
| Phone Number: | 8139777804 |
| Fax Number: | |
| NPI Enumeration Date: | 04/08/2010 |
| NPI Last Update Date: | 11/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME102530 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |