Healthcare Provider Details

I. General information

NPI: 1669400586
Provider Name (Legal Business Name): KENNETH ARTHUR NEIFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 PARK BLVD
SEMINOLE FL
33777-4119
US

IV. Provider business mailing address

2191 9TH AVENUE NORTH SUITE 110
ST PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 727-545-4545
  • Fax: 727-548-1360
Mailing address:
  • Phone: 727-820-7778
  • Fax: 727-820-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME64972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: