Provider Demographics
NPI:1134101744
Name:KENWARD, DEBRA G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:G
Last Name:KENWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6141 SUNSET DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5039
Mailing Address - Country:US
Mailing Address - Phone:305-667-4511
Mailing Address - Fax:305-667-0411
Practice Address - Street 1:6141 SUNSET DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5039
Practice Address - Country:US
Practice Address - Phone:305-667-4511
Practice Address - Fax:305-667-0411
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043412207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96792Medicare ID - Type Unspecified
FLD63995Medicare UPIN