MEDICARE: DR. KERRY MARIE WONG FIKE 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	207ND0101X	MOHS-Micrographic Surgery Physician	113221	FL

General Provider Information

NPI Number	:	1942297163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY MARIE WONG FIKE MD

Provider Business Mailing Address
First Line	:	15747 105TH DR N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-6813
Country	:	US
Telephone Number	:	315-296-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 HILLSIDE AVE STE 303
Second Line	:
City	:	NEEDHAM HEIGHTS
State	:	MA
Zip	:	02494-1228
Country	:	US
Telephone Number	:	781-449-3588
Fax Number	:	781-449-5474

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	10/10/2025

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