Provider Demographics
NPI:1891713236
Name:MONSON, KENNETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:MONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7850 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2114
Practice Address - Country:US
Practice Address - Phone:954-724-8500
Practice Address - Fax:954-724-2475
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0019485174400000X
FLME194852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0540757-00Medicaid
FL1974024OtherGHI
FL212045OtherAVMED
FLP934941OtherOPTIMUM
FLP993161OtherFREEDOM HEALTH
FLQMP000003701619OtherMOLINA
FL22472OtherMEDICA
FLP0003158OtherFLORIDA HEALTHCARE PLUS
FL06916OtherBCBS
FL01669246OtherAMERIGROUP
FL14221OtherWELLCARE
FL4611631OtherAETNA
FL2513287OtherCIGNA
FL2782OtherDIMENSION HEALTH
FLF00054827202OtherUNITED HEALTHCARE
FL1974024OtherGHI
FL06916WMedicare PIN
FL2513287OtherCIGNA
FL22472OtherMEDICA