Healthcare Provider Details

I. General information

NPI: 1992437495
Provider Name (Legal Business Name): KEF 17, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 N DALE MABRY HWY STE 325
TAMPA FL
33614-3860
US

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD STE 100
WEST PALM BEACH FL
33409-6500
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax:
Mailing address:
  • Phone: 516-507-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE YANTZ
Title or Position: HR
Credential:
Phone: 561-507-0800