Provider Demographics
NPI:1396732673
Name:TOURGEMAN, KENNETH JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOSEPH
Last Name:TOURGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2951 NW 49TH AVE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1600
Mailing Address - Country:US
Mailing Address - Phone:954-739-2221
Mailing Address - Fax:954-739-2271
Practice Address - Street 1:2951 NW 49TH AVE
Practice Address - Street 2:SUITE # 301
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1600
Practice Address - Country:US
Practice Address - Phone:954-739-2221
Practice Address - Fax:954-739-2271
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91281207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1046355OtherCAREPLUS
FL48977OtherB C B S
FL48977ZOtherMEDICARE ID
FL48977OtherB C B S