Provider Demographics
NPI:1720039662
Name:KESSELMAN, ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:KESSELMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 AVENTURA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-932-8441
Mailing Address - Fax:305-937-4238
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-932-8441
Practice Address - Fax:305-937-4238
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27403Medicare UPIN
FL82899ZMedicare ID - Type Unspecified