Healthcare Provider Details

I. General information

NPI: 1295736692
Provider Name (Legal Business Name): CAROLINE T KEDEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 11TH CR
VERO BEACH FL
32960-4804
US

IV. Provider business mailing address

3725 11TH CR
VERO BEACH FL
32960-4804
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-0163
  • Fax: 772-567-5631
Mailing address:
  • Phone: 772-562-0163
  • Fax: 772-567-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME90433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: