Provider Demographics
NPI:1518960053
Name:KASEMSAP, PACHAVIT (MD)
Entity type:Individual
Prefix:DR
First Name:PACHAVIT
Middle Name:
Last Name:KASEMSAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PACHAVIT
Other - Middle Name:
Other - Last Name:KASEMSAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2825 N STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5737
Mailing Address - Country:US
Mailing Address - Phone:954-975-0360
Mailing Address - Fax:954-975-3465
Practice Address - Street 1:2825 N STATE ROAD 7 STE 300
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-975-0360
Practice Address - Fax:954-975-3465
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269607000Medicaid
FL269607000Medicaid
FL81364YMedicare PIN