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General NPI Number Information
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NPI Number | 1114147261
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Entity Type | Organization
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Legal Business Name | KENNETH L DIRECTOR MD PA
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2525 20TH STREET
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City | VERO BEACH
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State | FL
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Zip | 32960-3026
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Country | US
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Telephone | 772-567-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 20TH STREET
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-567-6508
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH LOUIS DIRECTOR
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Credential | M.D.
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Telephone | 772-567-6508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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