Provider Demographics
NPI:1376552661
Name:GALANG, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:GALANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 07382
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0382
Mailing Address - Country:US
Mailing Address - Phone:239-225-0129
Mailing Address - Fax:239-225-0575
Practice Address - Street 1:13710 METROPOLIS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-225-0129
Practice Address - Fax:239-225-0575
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075093204C00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5705641OtherAETNA PPO
FL1631062002OtherCIGNA HMO
FL255349000Medicaid
FL592207264OtherCIGNA PPO
FL592207264EOtherHUMANA
FL44525OtherBCBS
FL2025126OtherAETNA HMO
FL1823430OtherUHC
FLP00134349Medicare PIN
FLE1083ZMedicare PIN
FL592207264EOtherHUMANA
FLG46942Medicare UPIN