Provider Demographics
NPI:1265401079
Name:KASTEN, ANN GLADYS (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GLADYS
Last Name:KASTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 NW BOCA RATON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1610
Mailing Address - Country:US
Mailing Address - Phone:561-886-2025
Mailing Address - Fax:561-886-1033
Practice Address - Street 1:1445 NW BOCA RATON BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-338-7722
Practice Address - Fax:561-338-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41279207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A59953Medicare UPIN
41279Medicare ID - Type Unspecified