Healthcare Provider Details

I. General information

NPI: 1669418398
Provider Name (Legal Business Name): KENNETH A SCHEPPKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PIKE RD
WEST PALM BEACH FL
33411-3815
US

IV. Provider business mailing address

PO BOX 2764
JUPITER FL
33468-2764
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-7000
  • Fax:
Mailing address:
  • Phone: 561-743-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME 68624
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME68624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: