Provider Demographics
NPI:1780659722
Name:FLANIGAN, KENNETH PAUL III (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:FLANIGAN
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:68 MARGINAL WAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2444
Mailing Address - Country:US
Mailing Address - Phone:207-879-1339
Mailing Address - Fax:207-879-1092
Practice Address - Street 1:68 MARGINAL WAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2444
Practice Address - Country:US
Practice Address - Phone:207-879-1339
Practice Address - Fax:207-879-1092
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPOD1033213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU80571Medicare UPIN
MEMM8323Medicare ID - Type UnspecifiedK. PAUL FLANIGAN, D.P.M.