Provider Demographics
NPI:1851365142
Name:KESDEN, DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:KESDEN
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 1:4850 W OAKLAND PARK BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:LANDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7261
Mailing Address - Country:US
Mailing Address - Phone:954-484-4440
Mailing Address - Fax:954-484-9250
Practice Address - Street 1:4850 W OAKLAND PARK BLVD
Practice Address - Street 2:STE 209
Practice Address - City:LANDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7261
Practice Address - Country:US
Practice Address - Phone:954-484-4440
Practice Address - Fax:954-484-9250
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24347207P00000X
FLME0024347207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062505100Medicaid
FL062505100Medicaid
FL71904SMedicare PIN