Provider Demographics
NPI:1376508317
Name:KENNETH A GIRALDO MD PA
Entity Type:Organization
Organization Name:KENNETH A GIRALDO MD 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:A
Authorized Official - Last Name:GIRALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-343-1040
Mailing Address - Street 1:5831 BEE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5088
Mailing Address - Country:US
Mailing Address - Phone:941-343-1040
Mailing Address - Fax:941-343-1098
Practice Address - Street 1:5831 BEE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5088
Practice Address - Country:US
Practice Address - Phone:941-343-1040
Practice Address - Fax:941-343-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL215811OtherAMERIGROUP
FLP00075216OtherMEDICARE RAILROAD
FL158358OtherSTAYWELL
FL44888OtherBCBS
FL2965791OtherAETNA
FLN80009-4201OtherPRINCIPAL LIFE
FL158358OtherSTAYWELL
FLN80009-4201OtherPRINCIPAL LIFE
FL2965791OtherAETNA