MEDICARE: DR. KENNETH RUSSELL FEUER 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	207RG0100X	Gastroenterology Physician	ME46704	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0624419	OTHER	FL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	47753	OTHER	FL	BC/BS
4	2900080	OTHER	FL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1902872781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RUSSELL FEUER MD

Provider Business Mailing Address
First Line	:	3885 OAKWATER CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-6257
Country	:	US
Telephone Number	:	407-851-5600
Fax Number	:	407-438-9585

Provider Business Practice Location Address
First Line	:	9430 TURKEY LAKE RD
Second Line	:	STE 206
City	:	ORLANDO
State	:	FL
Zip	:	32819-8015
Country	:	US
Telephone Number	:	407-851-5600
Fax Number	:	407-438-9585

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	10/21/2009

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