Provider Demographics
NPI:1407832793
Name:KRONBERG, KENNETH LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LLOYD
Last Name:KRONBERG
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 1:9417 W SAMPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-575-9710
Mailing Address - Fax:954-575-9968
Practice Address - Street 1:9417 W SAMPLE ROAD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-575-9710
Practice Address - Fax:954-575-9968
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0027724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
203473593OtherBEST CHOICE
3291ASOPOtherMYNHP
79397OtherBCBS
203473593OtherBEECH STREET
FL038370800Medicaid
170258OtherHUMANA
203473593OtherGREAT WEST HEALTH CARE
0228004OtherCIGNA
14126OtherWELL CARE STAY WELL HEALT
203473593OtherGOLDEN RULE
203473593OtherPHCS
241714OtherAVMED
0485782OtherAETNA PIN 4129065
203473593OtherFLORIDA HEALTH ADM
5661133OtherFIRST HEALTH CCN NETWORK
203473593OtherMEGA LIFE AND HEALTH
D58771OtherVISTA
79397OtherBCBS