MEDICARE: KENT N LEIFER 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	207KA0200X	Allergy Physician	ME24381	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AETNA 4028111	OTHER	FL	AETNA INSURANCE

General Provider Information

NPI Number	:	1336134634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT N LEIFER MD

Provider Business Mailing Address
First Line	:	375 S COURTENAY PKWY
Second Line	:	UNIT 4
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4886
Country	:	US
Telephone Number	:	321-452-4730
Fax Number	:	321-453-6681

Provider Business Practice Location Address
First Line	:	375 S COURTENAY PKWY
Second Line	:	UNIT 4
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4886
Country	:	US
Telephone Number	:	321-452-4730
Fax Number	:	321-453-6681

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	10/04/2011

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