Provider Demographics
NPI:1134398167
Name:ANDRONICO, KENNETH C (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:ANDRONICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:28945 STATE ROAD 54
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543
Mailing Address - Country:US
Mailing Address - Phone:813-907-0950
Mailing Address - Fax:813-907-7949
Practice Address - Street 1:28945 STATE ROAD 54
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-907-0950
Practice Address - Fax:813-907-7949
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2016-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS-0004967207W00000X
FL49672083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB41510Medicare UPIN