Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | D0066311 | MD |
N | 2086X0206X | Surgical Oncologist | M1824 | TX |
Y | 2086X0206X | Surgical Oncologist | ME131403 | FL |
NPI | 1093814758 |
---|---|
Provider Name | Susan B Kesmodel |
First Address | Miami, FL 33136 |
Second Address | Miami, FL 33136-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 18/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I48374 | (02) |