Provider Demographics
NPI:1093811762
Name:KENNETH A. HAMBERG, D.P.M., P.A.
Entity Type:Organization
Organization Name:KENNETH A. HAMBERG, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-655-1026
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 6600
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3427
Mailing Address - Country:US
Mailing Address - Phone:561-655-1026
Mailing Address - Fax:561-659-7270
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 6600
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3427
Practice Address - Country:US
Practice Address - Phone:561-655-1026
Practice Address - Fax:561-659-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0777900001OtherPALMETTO GBA
FL041343700Medicaid
FLT50936Medicare UPIN
FL041343700Medicaid