MEDICARE: KRISTIN E CLEMONS MD

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	208100000X	Physical Medicine & Rehabilitation Physician	52430	WI
2	208100000X	Physical Medicine & Rehabilitation Physician	079600	MI
3	208100000X	Physical Medicine & Rehabilitation Physician	ME137481	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00772226CD3624	OTHER	WI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	250E26047	OTHER	MI	BLUE CROSS BLUE SHIELD MI
5	LELVIKRI	OTHER	WI	MERCYCARE INSURANCE

General Provider Information

NPI Number	:	1376530618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN E CLEMONS MD

Provider Business Mailing Address
First Line	:	1317 EDGEWATER DR # 2945
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:	407-538-5921
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 CALYPSO CAY WAY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-5520
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/02/2026

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Directions to “ KRISTIN E CLEMONS MD” Practice Location

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