Provider Demographics
NPI:1811094154
Name:CHASTEK, KENNETH L (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:CHASTEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 LAKE KATHERINE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5003
Mailing Address - Country:US
Mailing Address - Phone:352-432-2578
Mailing Address - Fax:
Practice Address - Street 1:EMPLOYEE HEALTH SOLUTIONS
Practice Address - Street 2:245 SOUTH FENWAY
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-577-4300
Practice Address - Fax:307-577-4305
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS71650Medicare UPIN