Individual
KASEY A STATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 LAKELAND HILLS BLVD STE 1, LAKELAND, FL 33805-3257
(832) 242-4735
(239) 302-1344
Mailing address
4437 N CANDLEWOOD DR, BEVERLY HILLS, FL 34465-8907
(301) 254-4316
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101246540
VA
208000000X
Pediatrics Physician
21877
WV
208000000X
Pediatrics Physician
227551
NY
208000000X
Pediatrics Physician
Primary
ME114685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003695
—
WV
Enumeration date
06/01/2005
Last updated
11/27/2023
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