MEDICARE: KENNETH JOSEPH TOURGEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME91281	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	48977Z	OTHER	FL	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1046355	OTHER	FL	CAREPLUS
2	48977	OTHER	FL	B C B S

General Provider Information

NPI Number	:	1396732673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JOSEPH TOURGEMAN MD

Provider Business Mailing Address
First Line	:	2951 NW 49TH AVE
Second Line	:	SUITE #301
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1600
Country	:	US
Telephone Number	:	954-739-2221
Fax Number	:	954-739-2271

Provider Business Practice Location Address
First Line	:	2951 NW 49TH AVE
Second Line	:	SUITE # 301
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1600
Country	:	US
Telephone Number	:	954-739-2221
Fax Number	:	954-739-2271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	10/13/2020

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Directions to “ KENNETH JOSEPH TOURGEMAN MD” Practice Location

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