Provider Demographics
NPI:1053304436
Name:PLUNKITT, KENNETH WEBB (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WEBB
Last Name:PLUNKITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 PINE RIDGE RD UNIT 180
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3926
Mailing Address - Country:US
Mailing Address - Phone:239-263-0849
Mailing Address - Fax:239-263-2376
Practice Address - Street 1:6376 PINE RIDGE RD UNIT 180
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3926
Practice Address - Country:US
Practice Address - Phone:239-263-0849
Practice Address - Fax:239-263-2376
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69233207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00447918OtherRAIL ROAD MEDICARE
FL51308OtherBCBS
FL262136300Medicaid
FLP00206780OtherMEDICARE RR
FL262136300Medicaid
FL51308OtherBCBS
FLP00206780OtherMEDICARE RR