Provider Demographics
NPI:1912991811
Name:KASS, ETHAN BEN (DO MBA)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:BEN
Last Name:KASS
Suffix:
Gender:M
Credentials:DO MBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4923 NW 57TH LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2187
Mailing Address - Country:US
Mailing Address - Phone:954-796-5010
Mailing Address - Fax:954-796-9978
Practice Address - Street 1:8100 ROYAL PALM BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-796-5010
Practice Address - Fax:954-796-9978
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS46762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL527268Medicare ID - Type Unspecified