Provider Demographics
NPI:1356687487
Name:KENNETH H FARRELL M.D. PA
Entity Type:Organization
Organization Name:KENNETH H FARRELL M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-938-1890
Mailing Address - Street 1:6405 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1414
Mailing Address - Country:US
Mailing Address - Phone:954-938-1890
Mailing Address - Fax:
Practice Address - Street 1:6405 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1414
Practice Address - Country:US
Practice Address - Phone:954-938-1890
Practice Address - Fax:954-938-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19241207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55442Medicare UPIN
FL48770Medicare PIN
FL48770Medicare PIN