Provider Demographics
NPI:1194848424
Name:RILEY, HOSIE KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:HOSIE
Middle Name:KENNETH
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DR STE 210
Mailing Address - Street 2:ARIS RADIOLOGY
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4455
Mailing Address - Country:US
Mailing Address - Phone:330-655-1869
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:3430 TAMIAMI TRL
Practice Address - Street 2:SUITE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8148
Practice Address - Country:US
Practice Address - Phone:877-856-3774
Practice Address - Fax:239-599-2612
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME896822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA52435Medicare UPIN