Healthcare Provider Details

I. General information

NPI: 1619119922
Provider Name (Legal Business Name): JAMES E KASIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE SUITE 702
FORT MYERS FL
33901-5857
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3474
  • Fax: 239-343-2968
Mailing address:
  • Phone: 239-343-3474
  • Fax: 239-343-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME106967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: