Provider Demographics
NPI:1669400586
Name:NEIFELD, KENNETH ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ARTHUR
Last Name:NEIFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2191 9TH AVENUE NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7147
Mailing Address - Country:US
Mailing Address - Phone:727-820-7778
Mailing Address - Fax:727-820-7779
Practice Address - Street 1:8900 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4119
Practice Address - Country:US
Practice Address - Phone:727-545-4545
Practice Address - Fax:727-548-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373852300Medicaid
FLB35330Medicare UPIN