Provider Demographics
NPI:1679591275
Name:TOLEP, KENNETH A (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:TOLEP
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-985-1929
Mailing Address - Fax:239-468-7929
Practice Address - Street 1:16271 BASS RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3616
Practice Address - Country:US
Practice Address - Phone:239-985-1929
Practice Address - Fax:239-468-7929
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071219207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251046400Medicaid
FL9292481OtherCIGNA
FL32365OtherBCBS OF FL
FLP01319833OtherRR MEDICARE
FL231195OtherAVMED
FL4202982OtherAETNA
FLP107184OtherFREEDOM
FLP203275OtherOPTIMUM
FL9292481OtherCIGNA
FL32365YMedicare PIN
FL32365XMedicare PIN
E85180Medicare UPIN