1316943905 NPI number — MICHAEL J KERKES MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316943905 NPI number — MICHAEL J KERKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERKES
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316943905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4614 S KIRKMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32811-2891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-512-5700
Provider Business Mailing Address Fax Number:
800-752-1493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4614 S KIRKMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32811-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-512-5700
Provider Business Practice Location Address Fax Number:
800-752-1493
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME44739 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593516436003 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7194953 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 773114 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593516436 . This is a "MEDICAL MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47696 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 695956 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00397528 . This is a "RR GBA MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com