# KERSENBROCK MEDICAL AND WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154816510
- **Authorized official:** BENJAMIN DALE KERSENBROCK (OWNER)
- **Authorized official phone:** (407) 732-6920

## Contact information

- **Practice address:** 760 CURRENCY CIR STE A, LAKE MARY, FL 32746-2138
- **Practice address phone:** (407) 732-6920
- **Practice address fax:** (407) 732-6923
- **Mailing address:** 760 CURRENCY CIR STE A, LAKE MARY, FL 32746-2138
- **Mailing address phone:** (407) 732-6920
- **Mailing address fax:** (407) 732-6923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/28/2018
- **Last updated:** 06/28/2018