Provider Demographics
NPI:1275637951
Name:GREENWOOD, KENNETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:951 PONDELLA RD
Mailing Address - Street 2:COASTAL BEHAVIORAL HEALTHCARE
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3532
Mailing Address - Country:US
Mailing Address - Phone:239-656-3461
Mailing Address - Fax:239-656-3462
Practice Address - Street 1:951 PONDELLA RD
Practice Address - Street 2:COASTAL BEHAVIORAL HEALTHCARE
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3532
Practice Address - Country:US
Practice Address - Phone:239-656-3461
Practice Address - Fax:239-656-3462
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN296872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013306OtherCIGNA MCC
VA0100725315 EASTMedicaid
3085173OtherMAGELLAN PINNACLE
620582605OtherMENTAL HEALTH NETW
620582605OtherHIGHLANDS WELLMONT
620582605OtherINITIAL GROUP
620582605OtherCARITEN PHP POS
620582605W5OtherUBH JOHN DEERE
3085173OtherMAGELLAN SUMMIT
620582605OtherCARITEN PHP PPO
620582605OtherBEECH STREET
620582605OtherCORPHEALTH
3085173OtherMAGELLAN NAVIGATOR
334969OtherVALUEOPTIONS GROUP
620582605OtherCARITEN PHP HMO
107340OtherUBH HEALTHPLAN
620582605OtherPHCS
620582605OtherHIGHLANDS WELLMONT
3085173OtherMAGELLAN NAVIGATOR
TN3855908Medicare ID - Type Unspecified