Individual
THAD KAMMERLOCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6821 PALISADES PARK CT, SUITE 1, FORT MYERS, FL 33912-7131
(239) 936-8555
(239) 936-5611
Mailing address
6821 PALISADES PARK CT, SUITE 1, FORT MYERS, FL 33912-7131
(239) 936-8555
(239) 936-5611
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME65374
FL
2086S0129X
Vascular Surgery Physician
ME65374
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256427100
—
FL
01
—
260837
AVMED
—
01
—
2759634
CIGNA PROVIDER #
FL
01
—
46591
BCBS PROVIDER #
FL
01
—
7267021
AETNA PROVIDER #
FL
01
—
P00449663
RAIL ROAD MEDICARE
FL
Enumeration date
04/18/2006
Last updated
03/11/2016
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