Provider Demographics
NPI:1073519310
Name:ESSIG, KENNETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:ESSIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7599 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3263
Mailing Address - Country:US
Mailing Address - Phone:863-845-2688
Mailing Address - Fax:863-291-6050
Practice Address - Street 1:7599 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3263
Practice Address - Country:US
Practice Address - Phone:863-845-2688
Practice Address - Fax:863-291-6050
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 73354208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014245200Medicaid
FL014245200Medicaid
FL41337UMedicare PIN
FL41337YMedicare PIN
FL41337VMedicare PIN