Healthcare Provider Details

I. General information

NPI: 1922036995
Provider Name (Legal Business Name): DANIEL H KETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE # C455A JACKSON MEMORIAL HOSPITAL
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1500 NW 12TH AVENUE JMT EAST 1007
MIAMI FL
33136-1028
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6664
  • Fax: 305-585-0086
Mailing address:
  • Phone: 305-243-4664
  • Fax: 305-243-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME51707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: