Provider Demographics
NPI:1245911353
Name:KP MEDICAL CENTER CORP
Entity type:Organization
Organization Name:KP MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-308-6024
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD STE 1R
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4511
Mailing Address - Country:US
Mailing Address - Phone:786-542-5173
Mailing Address - Fax:786-536-2512
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 1R
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4511
Practice Address - Country:US
Practice Address - Phone:786-542-5173
Practice Address - Fax:786-536-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty