Provider Demographics
NPI:1326205238
Name:HAMWI, KRISTOPHER BLAKE (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:BLAKE
Last Name:HAMWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5566 BROADCAST CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8471
Mailing Address - Country:US
Mailing Address - Phone:941-800-2000
Mailing Address - Fax:941-800-3000
Practice Address - Street 1:5566 BROADCAST CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8471
Practice Address - Country:US
Practice Address - Phone:941-800-2000
Practice Address - Fax:941-800-3000
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248740208200000X
NY2833252086S0122X
FLME1358962086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery