Provider Demographics
NPI:1063449494
Name:HURWITZ, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:HURWITZ
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 1:1921 WALDEMERE ST
Mailing Address - Street 2:STE. 705
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-366-5864
Mailing Address - Fax:941-365-4276
Practice Address - Street 1:1921 WALDEMERE ST STE 705
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2913
Practice Address - Country:US
Practice Address - Phone:941-366-5864
Practice Address - Fax:941-365-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63644207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH13478Medicare UPIN