Healthcare Provider Details

I. General information

NPI: 1376656165
Provider Name (Legal Business Name): JAMES MICHAEL KEMMERLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16553 S US HIGHWAY 301
WIMAUMA FL
33598-2032
US

IV. Provider business mailing address

3810 NORTHDALE BLVD STE 150
TAMPA FL
33624-1871
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax: 888-812-8191
Mailing address:
  • Phone: 813-961-1331
  • Fax: 888-850-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35428
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME141776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: