Provider Demographics
NPI:1447210372
Name:RAPPAPORT, KENNETH ALAN (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 PGA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2824
Mailing Address - Country:US
Mailing Address - Phone:561-296-8042
Mailing Address - Fax:561-766-2159
Practice Address - Street 1:3401 PGA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2824
Practice Address - Country:US
Practice Address - Phone:561-296-8042
Practice Address - Fax:561-766-2159
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43853207R00000X
FLME0043853207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035109100Medicaid
FL035109100Medicaid
FL07732YMedicare ID - Type Unspecified