Individual Professional Information |
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NPI
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1659434124
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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4082777602
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20090108000271
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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MADORE
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Individual professional last name
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Provider First Name
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KENNETH
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Individual professional first name
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Provider Gender
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M
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The provider's gender if the provider is a person.
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