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NPI Code Detail

MEDICARE: DR. KENNETH JEFFREY SALUCK DO

MEDICARE: DR. KENNETH JEFFREY SALUCK DO
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
1207Q00000XFamily Medicine PhysicianOS5538FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3RX203OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
280348OTHERFLBCBS

General Provider Information

NPI Number : 1477548964
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH JEFFREY SALUCK DO
Provider Business Mailing Address
First Line : 5151 BABCOCK ST NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4610
Country : US
Telephone Number : 321-567-7760
Fax Number :
Provider Business Practice Location Address
First Line : 1250 GRUMMAN PL STE B
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7927
Country : US
Telephone Number : 321-267-0060
Fax Number : 321-269-4240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 01/28/2025

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