Provider Demographics
NPI:1942297163
Name:FIKE, KERRY MARIE WONG (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:MARIE WONG
Last Name:FIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:MARIE
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15747 105TH DR N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6813
Mailing Address - Country:US
Mailing Address - Phone:315-296-5801
Mailing Address - Fax:
Practice Address - Street 1:1500 N DIXIE HWY STE 305
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2717
Practice Address - Country:US
Practice Address - Phone:561-655-9055
Practice Address - Fax:561-655-9233
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113221207ND0101X
MA213213207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery