Healthcare Provider Details

I. General information

NPI: 1134632169
Provider Name (Legal Business Name): KASMITH-DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SE FEDERAL HWY
STUART FL
34994-4533
US

IV. Provider business mailing address

8880 S OCEAN DR APT 1309
JENSEN BEACH FL
34957-2141
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-4911
  • Fax:
Mailing address:
  • Phone: 517-927-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14307
License Number StateFL

VIII. Authorized Official

Name: DR. KERRI ANNE DEMBOWSKE
Title or Position: PRESIDENT
Credential: DO
Phone: 517-927-6542