Provider Demographics
NPI:1144205188
Name:BENGTSON, KENNETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:BENGTSON
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 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:561-712-6265
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:8150 CHANCELLOR DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7691
Practice Address - Country:US
Practice Address - Phone:407-587-4243
Practice Address - Fax:407-251-5053
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72874207ZH0000X
FLME0072874207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38060ZMedicare PIN
FL38060UMedicare PIN
FL38060YMedicare PIN
FLG488674Medicare UPIN