Provider Demographics
NPI:1699008102
Name:CARSTENSEN INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:CARSTENSEN INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:CARSTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-295-6790
Mailing Address - Street 1:731 WADDELL AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4779
Mailing Address - Country:US
Mailing Address - Phone:305-517-6792
Mailing Address - Fax:305-328-8212
Practice Address - Street 1:2505 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3934
Practice Address - Country:US
Practice Address - Phone:305-295-6790
Practice Address - Fax:305-328-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001716400Medicaid
FL001716400Medicaid