Provider Demographics
NPI:1881792349
Name:BOOKMAN, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BOOKMAN
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 1:3021 AIRPORT-PULLING ROAD NO
Mailing Address - Street 2:ST 103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105
Mailing Address - Country:US
Mailing Address - Phone:239-208-0831
Mailing Address - Fax:305-721-1545
Practice Address - Street 1:3021 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-3077
Practice Address - Country:US
Practice Address - Phone:239-421-3700
Practice Address - Fax:239-430-7824
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92562207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16528OtherBCBS
FL273218100Medicaid
FL16528WMedicare PIN
FL273218100Medicaid