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Individual

KEVIN J DESANTIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1912 KINGS HWY UNIT 700, PORT CHARLOTTE, FL 33980-4305
(941) 255-0032
(941) 391-5213
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME58093
FL
208D00000X
General Practice Physician
Primary
ME58093
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
064805100
FL
Enumeration date
07/24/2006
Last updated
06/03/2024
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