Healthcare Provider Details

I. General information

NPI: 1548219058
Provider Name (Legal Business Name): KENNETH PETER ORBECK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 21ST AVE N SUITE 105
MYRTLE BEACH SC
29577-7401
US

IV. Provider business mailing address

1240 21ST AVE N STE 105
MYRTLE BEACH SC
29577-7431
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-0270
  • Fax: 843-839-0276
Mailing address:
  • Phone: 843-839-0270
  • Fax: 843-839-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0513
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: