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NPI Code Detail

MEDICARE: JONATHAN G KERTICH DO

MEDICARE: JONATHAN G KERTICH 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
1208600000XSurgery PhysicianUO10724FL

General Provider Information

NPI Number : 1750183406
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN G KERTICH DO
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number : 863-687-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2025
Last Update Date : 05/08/2026

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Directions to “ JONATHAN G KERTICH DO” Practice Location

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