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NPI Code Detail

MEDICARE: MR. KEVIN JAMES KENEMUTH AP

MEDICARE: MR. KEVIN JAMES KENEMUTH AP
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
1171100000XAcupuncturistAP2007FL

General Provider Information

NPI Number : 1417913963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN JAMES KENEMUTH AP
Provider Business Mailing Address
First Line : 524 1ST ST S
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3601
Country : US
Telephone Number : 863-293-5033
Fax Number :
Provider Business Practice Location Address
First Line : 524 1ST ST S
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3601
Country : US
Telephone Number : 863-293-5033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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