Healthcare Provider Details

I. General information

NPI: 1316943905
Provider Name (Legal Business Name): MICHAEL J KERKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 S KIRKMAN RD
ORLANDO FL
32811-2891
US

IV. Provider business mailing address

4614 S KIRKMAN RD
ORLANDO FL
32811-2891
US

V. Phone/Fax

Practice location:
  • Phone: 407-512-5700
  • Fax: 800-752-1493
Mailing address:
  • Phone: 407-512-5700
  • Fax: 800-752-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME44739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: