Provider Demographics
NPI:1619332814
Name:KENT N LEIFER MD
Entity Type:Organization
Organization Name:KENT N LEIFER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-452-4730
Mailing Address - Street 1:375 S COURTENAY PKWY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4886
Mailing Address - Country:US
Mailing Address - Phone:321-452-4730
Mailing Address - Fax:321-453-6681
Practice Address - Street 1:375 S COURTENAY PKWY
Practice Address - Street 2:UNIT 4
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4886
Practice Address - Country:US
Practice Address - Phone:321-452-4730
Practice Address - Fax:321-453-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24381207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277294900Medicaid
FLD58633Medicare UPIN