Provider Demographics
NPI:1215107396
Name:FRANK D KUITEMS MD PC
Entity type:Organization
Organization Name:FRANK D KUITEMS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUITEMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-227-8653
Mailing Address - Street 1:1940 S FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4534
Mailing Address - Country:US
Mailing Address - Phone:904-477-6525
Mailing Address - Fax:912-882-9493
Practice Address - Street 1:130 N GROSS ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6263
Practice Address - Country:US
Practice Address - Phone:912-227-8653
Practice Address - Fax:912-882-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00302585BMedicaid
GA00302585BMedicaid
GA142483961DMedicare PIN