Provider Demographics
NPI:1023078532
Name:WRITESEL, KENNETH ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:WRITESEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TAMIAMI TRL N STE 162
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5803
Mailing Address - Country:US
Mailing Address - Phone:239-316-3323
Mailing Address - Fax:
Practice Address - Street 1:340 TAMIAMI TRL N STE 162
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5803
Practice Address - Country:US
Practice Address - Phone:239-316-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004278207QG0300X, 207Q00000X
OH34.004278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0667443Medicaid
OH202602OtherFEDERAL BLACK LUNG
OH000000224730OtherANTHEM
OH7300022OtherUNITED HEALTHCARE
OH0667443Medicaid
OH7300022OtherUNITED HEALTHCARE
OHE00748Medicare UPIN