Provider Demographics
NPI:1316902455
Name:LIVINGSTONE, KERI LEE
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:LEE
Last Name:LIVINGSTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NE 95 ST
Mailing Address - Street 2:STE 1
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138
Mailing Address - Country:US
Mailing Address - Phone:305-751-8071
Mailing Address - Fax:305-751-3045
Practice Address - Street 1:660 NE 95 ST
Practice Address - Street 2:STE 1
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138
Practice Address - Country:US
Practice Address - Phone:305-751-8071
Practice Address - Fax:305-751-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81709207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
M49441Medicare UPIN