Provider Demographics
NPI:1962485466
Name:SAVAGE, KENNETH L (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:SAVAGE
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 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:308 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4716
Practice Address - Country:US
Practice Address - Phone:352-726-8353
Practice Address - Fax:352-726-5038
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34752207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060013026OtherMEDICARE RR
FL269859500OtherMEDICAID GROUP
FL77940OtherMEDICARE GROUP ID
FLME0034752OtherSTATE LICENSE NUMBER
FL039421100Medicaid
FL09039OtherBCBS OF FL
FLCF1416OtherMEDICARE RR GROUP
FL113193885OtherCAQH
FL77940OtherBCBS OF FL GROUP ID
FL4450864OtherCIGNA
FL269859500OtherMEDICAID GROUP
FL09039ZMedicare PIN