=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326205238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTOPHER BLAKE HAMWI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 05/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5566 BROADCAST CT
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-8471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-800-2000
-----------------------------------------------------
Fax | 941-800-3000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5566 BROADCAST CT
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-8471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-800-2000
-----------------------------------------------------
Fax | 941-800-3000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 0101248740
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | 283325
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | ME135896
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------