Healthcare Provider Details

I. General information

NPI: 1134101744
Provider Name (Legal Business Name): DEBRA G KENWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5039
US

IV. Provider business mailing address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5039
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-4511
  • Fax: 305-667-0411
Mailing address:
  • Phone: 305-667-4511
  • Fax: 305-667-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0043412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: