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NPI Code Detail

MEDICARE: DR. KEITH KANAREK M.D.

MEDICARE: DR. KEITH KANAREK M.D.
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
12080N0001XNeonatal-Perinatal Medicine PhysicianME0026525FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
148872OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1568411957
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH KANAREK M.D.
Provider Business Mailing Address
First Line : PO BOX 863298
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3298
Country : US
Telephone Number : 727-767-4378
Fax Number :
Provider Business Practice Location Address
First Line : 880 6TH ST S
Second Line : SUITE 470
City : SAINT PETERSBURG
State : FL
Zip : 33701-4827
Country : US
Telephone Number : 727-767-4313
Fax Number : 727-767-4391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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