Provider Demographics
NPI:1588684591
Name:KASKEL, STEWART M (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:M
Last Name:KASKEL
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 1:1905 CLINT MOORE RD
Mailing Address - Street 2:STE 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2661
Mailing Address - Country:US
Mailing Address - Phone:561-487-1544
Mailing Address - Fax:561-487-4811
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:STE 310
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2661
Practice Address - Country:US
Practice Address - Phone:561-487-1544
Practice Address - Fax:561-487-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D67380Medicare UPIN
79942Medicare ID - Type Unspecified