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General NPI Number Information
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NPI Number | 1477548964
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Entity Type | Individual
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Provider Name | KENNETH JEFFREY SALUCK DO
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1250 GRUMMAN PL STE B
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City | TITUSVILLE
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State | FL
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Zip | 32780-7927
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Country | US
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Telephone | 321-267-0060
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Fax | 321-269-4240
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Provider Business Mailing Address
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Address Line | 5151 BABCOCK ST NE
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City | PALM BAY
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State | FL
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Zip | 32905-4610
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Country | US
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Telephone | 321-567-7760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS5538
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License Number State | FL
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