Basic Information
| Provider Information | |||||||||
| NPI: | 1174013429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASHEM | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HEDEMANN | ||||||||
| OtherFirstName: | ERIN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1235 NW 128TH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331672229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053282382 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MS 09-5030 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722190 | ||||||||
| FaxNumber: | 5052723466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2018 | ||||||||
| LastUpdateDate: | 05/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NM | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.