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NPI Code Detail

MEDICARE: KENNETH GUSTKE MD

MEDICARE:   KENNETH  GUSTKE  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery PhysicianME38723FL
2207X00000XOrthopaedic Surgery PhysicianME38723FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200001638OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
230375OTHERFLBCBS FLORIDA
34240449OTHERFLAETNA
42314249OTHERFLCIGNA
5211378OTHERFLAVMED
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144225855
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH GUSTKE MD
Provider Business Mailing Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-972-5055
Provider Business Practice Location Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-558-6129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 05/14/2018

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Directions to “ KENNETH GUSTKE MD” Practice Location

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