Provider Demographics
NPI:1881786796
Name:WOLINER, KENNETH NOAH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NOAH
Last Name:WOLINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 GLADES ROAD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-620-7779
Mailing Address - Fax:561-367-9509
Practice Address - Street 1:9325 GLADES ROAD
Practice Address - Street 2:SUITE # 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-620-7779
Practice Address - Fax:561-367-9509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME80412OtherMEDICAL LICENSE NUMBER
FLME80412OtherMEDICAL LICENSE NUMBER
FL35788XMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID#