Provider Demographics
NPI:1487726345
Name:KENNETH ALLEN KASTEN MD PA
Entity type:Organization
Organization Name:KENNETH ALLEN KASTEN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-737-4040
Mailing Address - Street 1:10301 HAGEN RANCH ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3781
Mailing Address - Country:US
Mailing Address - Phone:561-737-4040
Mailing Address - Fax:561-369-7104
Practice Address - Street 1:10301 HAGEN RANCH ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7861
Practice Address - Country:US
Practice Address - Phone:561-737-4040
Practice Address - Fax:561-369-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48537207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0695820001Medicare NSC
FLD50387Medicare UPIN
02186Medicare PIN