Provider Demographics
NPI:1679533954
Name:KASTENSMIDT, DAVID JANES (MSH RD LD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JANES
Last Name:KASTENSMIDT
Suffix:
Gender:M
Credentials:MSH RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5009 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1150
Mailing Address - Country:US
Mailing Address - Phone:352-392-4493
Mailing Address - Fax:352-846-2333
Practice Address - Street 1:5009 NW 34TH STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1150
Practice Address - Country:US
Practice Address - Phone:352-392-4493
Practice Address - Fax:352-846-2333
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL948426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
U3642ZMedicare UPIN