Provider Demographics
NPI:1508847500
Name:VIVES, KENNETH P (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:VIVES
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 1:5831 BEE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5088
Mailing Address - Country:US
Mailing Address - Phone:941-308-5700
Mailing Address - Fax:941-308-5757
Practice Address - Street 1:5831 BEE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5088
Practice Address - Country:US
Practice Address - Phone:941-308-5700
Practice Address - Fax:941-308-5757
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121748207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45130Medicare UPIN
CT140000191Medicare ID - Type Unspecified
CT001396929Medicaid