MEDICARE: FREDERICK MICHAEL KAESTEL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00365200	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	213ES0103X	Foot & Ankle Surgery Podiatrist	2535	MA

General Provider Information

NPI Number	:	1336769447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK MICHAEL KAESTEL DPM

Provider Business Mailing Address
First Line	:	27005 76TH AVE BLDG C
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 MAIN ST
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-5639
Country	:	US
Telephone Number	:	508-842-7910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	03/20/2023

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