1407832793 NPI number — KENNETH LLOYD KRONBERG M.D.

Table of content: DR. AHMAD KAZEMI MD (NPI 1588640874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407832793 NPI number — KENNETH LLOYD KRONBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRONBERG
Provider First Name:
KENNETH
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1407832793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9417 W SAMPLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-575-9710
Provider Business Mailing Address Fax Number:
954-575-9968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9417 W SAMPLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-575-9710
Provider Business Practice Location Address Fax Number:
954-575-9968
Provider Enumeration Date:
12/19/2005

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: 208000000X , with the licence number:  ME 0027724 , 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: 203473593 . This is a "BEST CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3291ASOP . This is a "MYNHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 79397 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 038370800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170258 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "GREAT WEST HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0228004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14126 . This is a "WELL CARE STAY WELL HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "GOLDEN RULE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 241714 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0485782 . This is a "AETNA PIN 4129065" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "FLORIDA HEALTH ADM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5661133 . This is a "FIRST HEALTH CCN NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203473593 . This is a "MEGA LIFE AND HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: D58771 . This is a "VISTA" identifier . This identifiers is of the category "OTHER".




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