Healthcare Provider Details

I. General information

NPI: 1093004160
Provider Name (Legal Business Name): KENNETH CERRETA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 405
CLEARWATER FL
33756-3394
US

IV. Provider business mailing address

430 MORTON PLANT ST STE 405
CLEARWATER FL
33756-3394
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-0611
  • Fax: 727-461-5493
Mailing address:
  • Phone: 727-443-0611
  • Fax: 727-461-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME131027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: