Provider Demographics
NPI:1134632169
Name:KASMITH-DO PLLC
Entity type:Organization
Organization Name:KASMITH-DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DEMBOWSKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-927-6542
Mailing Address - Street 1:8880 S OCEAN DR APT 1309
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2141
Mailing Address - Country:US
Mailing Address - Phone:517-927-6540
Mailing Address - Fax:
Practice Address - Street 1:2520 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4533
Practice Address - Country:US
Practice Address - Phone:772-288-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty