Provider Demographics
NPI:1043212913
Name:MCARTHUR, KENDRICK D (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:D
Last Name:MCARTHUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:21 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7531
Practice Address - Country:US
Practice Address - Phone:239-939-2616
Practice Address - Fax:239-939-9093
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00855OtherFREEDOM
FL48207OtherBCBS
FL7870557OtherAETNA
FL1261702OtherWELLCARE
FL014715000Medicaid
FLP01704528OtherCLEAR HEALTH ALLIANCE
FLP01618515OtherRR MEDICARE
FL270636900Medicaid
FL294587OtherAVMED
FL6862123OtherCIGNA
FLP947106OtherOPTIMUM
FLP947106OtherOPTIMUM
FL7870557OtherAETNA
FL1261702OtherWELLCARE