Provider Demographics
NPI:1841277225
Name:KASZUBA, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KASZUBA
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 1:1803 BRIAR CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3676
Mailing Address - Country:US
Mailing Address - Phone:727-216-0505
Mailing Address - Fax:727-789-8261
Practice Address - Street 1:1803 BRIAR CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3676
Practice Address - Country:US
Practice Address - Phone:727-216-0505
Practice Address - Fax:727-789-8261
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41937OtherBS FLORIDA
103352OtherCITRUS HEALTHCARE
213854OtherAMERIGROUP
5233614OtherAETNA
FL255544101Medicaid
FL41937XMedicare PIN
FL41937OtherBS FLORIDA