Provider Demographics
NPI:1588604870
Name:KAILES, STEVEN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BENJAMIN
Last Name:KAILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8761 PERIMETER PARK BLVD STE 106
Mailing Address - Street 2:SOUTHEAST EMERGENCY CONSULTANTS
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6397
Mailing Address - Country:US
Mailing Address - Phone:904-641-6628
Mailing Address - Fax:904-642-1243
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:ORANGE PARK MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5148
Practice Address - Country:US
Practice Address - Phone:904-276-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91282207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275631500Medicaid
U7572ZMedicare PIN
I54383Medicare UPIN