Healthcare Provider Details

I. General information

NPI: 1952154379
Provider Name (Legal Business Name): MR. KENNETH JAMES BEITER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 GUNN HWY
TAMPA FL
33624-6379
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 813-733-8572
  • Fax:
Mailing address:
  • Phone: 844-406-3878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: