Provider Demographics
NPI:1013944586
Name:MCCRACKEN, KEVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:MCCRACKEN
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 1:7331 COLLEGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5524
Mailing Address - Country:US
Mailing Address - Phone:239-337-2003
Mailing Address - Fax:239-337-3168
Practice Address - Street 1:7331 COLLEGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5524
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:239-337-3168
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148018207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7795700Medicaid
NJ001396Medicare ID - Type Unspecified
NJ7795700Medicaid