Provider Demographics
NPI:1811963473
Name:PRITCHYK, KENNETH P (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:P
Last Name:PRITCHYK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460
Mailing Address - Country:US
Mailing Address - Phone:352-746-0077
Mailing Address - Fax:352-746-1704
Practice Address - Street 1:2385 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-746-0077
Practice Address - Fax:352-746-1704
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO02787213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340119700Medicaid
U75254Medicare UPIN
FL65611ZMedicare PIN