NPIMap

Organization Active NPI

Kersenbrock Medical and Wellness, LLC

  • General Practice Physician
  • Lake Mary, FL
National Provider Identifier
1154816510
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
KERSENBROCK MEDICAL AND WELLNESS, LLC
Practice address
760 Currency Cir Ste a
Lake Mary, FL 32746-2138
Phone
(407) 732-6920
Fax
(407) 732-6923
NPI assigned
Jun 28, 2018
Last updated
Jun 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benjamin Dale KersenbrockNPI 1154609345
Title
Owner
Phone
(407) 732-6920

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

760 Currency Cir Ste a
Lake Mary, FL 32746-2138

Mailing address

760 Currency Cir Ste a
Lake Mary, FL 32746-2138
Phone (407) 732-6920

National Provider Directory

National Provider Directory

Locations

760 Currency Cir
Ste A
Lake Mary, FL 32746
Phone (407) 516-8997

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1154816510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 CURRENCY CIR STE A",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462138",
            "telephone_number": "407-732-6920",
            "fax_number": "407-732-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 CURRENCY CIR STE A",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462138",
            "telephone_number": "407-732-6920",
            "fax_number": "407-732-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERSENBROCK MEDICAL AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "KERSENBROCK",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-732-6920"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.