MEDICARE: DR. KENNETH A CIARDIELLO 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
1	208600000X	Surgery Physician	ME134560	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KG508	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	31AWY	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184719395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A CIARDIELLO MD

Provider Business Mailing Address
First Line	:	6400 DAVIS BLVD STE 104
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5321
Country	:	US
Telephone Number	:	239-624-0650
Fax Number	:	239-624-0651

Provider Business Practice Location Address
First Line	:	6400 DAVIS BLVD STE 104
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5321
Country	:	US
Telephone Number	:	239-624-0650
Fax Number	:	239-624-0651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/30/2018

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Directions to “ DR. KENNETH A CIARDIELLO MD” Practice Location

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