MEDICARE: KENNETH ALONSO M.D.

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	207P00000X	Emergency Medicine Physician	35075309	OH
2	208M00000X	Hospitalist Physician	ME97444	FL
3	207R00000X	Internal Medicine Physician	ME97444	FL

General Provider Information

NPI Number	:	1962580829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH ALONSO M.D.

Provider Business Mailing Address
First Line	:	1090 W STATE ROAD 436
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2921
Country	:	US
Telephone Number	:	407-869-1030
Fax Number	:	407-869-1025

Provider Business Practice Location Address
First Line	:	1090 W STATE ROAD 436
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2921
Country	:	US
Telephone Number	:	407-869-1030
Fax Number	:	407-869-1025

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/09/2026

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