Provider Demographics
NPI:1639361447
Name:CALDER, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CALDER
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 1:14275 MIDWAY RD
Mailing Address - Street 2:STE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3676
Mailing Address - Country:US
Mailing Address - Phone:800-330-6565
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:10500 UNIVERSITY CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6494
Practice Address - Country:US
Practice Address - Phone:800-929-6694
Practice Address - Fax:813-971-6675
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN8901390200000X
FLME108309207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program