Healthcare Provider Details

I. General information

NPI: 1841299625
Provider Name (Legal Business Name): KENNETH MICHAEL SEKINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 SAN JOSE BLVD 400
JACKSONVILLE FL
32223-1613
US

IV. Provider business mailing address

11945 SAN JOSE BLVD 400
JACKSONVILLE FL
32223-1613
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-5333
  • Fax: 904-262-5337
Mailing address:
  • Phone: 904-262-5333
  • Fax: 904-262-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME30838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: