Provider Demographics
NPI:1033123948
Name:POSS, KENNETH D (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:POSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:SUITE 301 BLDG E
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-499-5757
Mailing Address - Fax:561-865-2225
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:SUITE 301 BLDG E
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-499-5757
Practice Address - Fax:561-865-2225
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKP000796213E00000X
FLPO990213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34419Medicare UPIN
MI5635106Medicare ID - Type Unspecified
FL65408Medicare ID - Type Unspecified