Healthcare Provider Details

I. General information

NPI: 1629158472
Provider Name (Legal Business Name): JAY F KIOKEMEISTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E VENICE AVE
VENICE FL
34285-9066
US

IV. Provider business mailing address

LBX 809274, PO BOX 809274
CHICAGO IL
60680-9274
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-2030
  • Fax:
Mailing address:
  • Phone: 773-445-9696
  • Fax: 773-445-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-086579
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS21514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: