Provider Demographics
NPI:1235305038
Name:FEO, KENNETH ROCCO
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROCCO
Last Name:FEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BAHIA TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-2163
Mailing Address - Country:US
Mailing Address - Phone:352-680-9555
Mailing Address - Fax:352-680-9555
Practice Address - Street 1:65 BAHIA TRACE CIR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2163
Practice Address - Country:US
Practice Address - Phone:352-680-9555
Practice Address - Fax:352-680-9555
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230064800Medicaid