Basic Information
| Provider Information | |||||||||
| NPI: | 1669400586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIFELD | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2191 9TH AVENUE NORTH | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337137147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278207778 | ||||||||
| FaxNumber: | 7278207779 | ||||||||
| Practice Location | |||||||||
| Address1: | 8900 PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337774119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275454545 | ||||||||
| FaxNumber: | 7275481360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME64972 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 373852300 | 05 | FL | MEDICAID |