Healthcare Provider Details

I. General information

NPI: 1801387709
Provider Name (Legal Business Name): KENNETH MICHAEL TODD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4891
US

IV. Provider business mailing address

701 6TH ST S
ST PETERSBURG FL
33701-4891
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2335
  • Fax:
Mailing address:
  • Phone: 321-841-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS18871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: