Healthcare Provider Details

I. General information

NPI: 1306983234
Provider Name (Legal Business Name): KEVIN JENSEN HOHNWALD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 STERLING LN
SARASOTA FL
34231-6534
US

IV. Provider business mailing address

2929 STERLING LN
SARASOTA FL
34231-6534
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-4523
  • Fax: 941-921-7609
Mailing address:
  • Phone: 941-921-4523
  • Fax: 941-921-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: