Kenneth a. Berdick, M.D., P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME0017772 Issued in FL

Legal business name

KENNETH A. BERDICK, M.D., P.A.

Practice address

3714 Evans Ave
Fort Myers, FL 33901-9303

Phone

(239) 334-4157

Fax

(239) 334-1904

NPI assigned

May 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth A Berdick, M.D.

Title

President

Phone

(239) 334-4157

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348444800000",
    "number": "1508125170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3714 EVANS AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019303",
            "telephone_number": "239-334-4157",
            "fax_number": "239-334-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3714 EVANS AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019303",
            "telephone_number": "239-334-4157",
            "fax_number": "239-334-1904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH A. BERDICK, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-16",
        "last_updated": "2012-09-24",
        "status": "A",
        "authorized_official_last_name": "BERDICK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-334-4157",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0017772",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "NP1971252",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "91309",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066122800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mariah Kenagy
• Daniel Kennedy, MD
• Jessica Kennedy, APRN
• Johnathan Kennedy, MD
• Erica A Kennerly
• Kenneth J. Galang, M.D., P.a.
• Elizabeth Ann Kenney, DPT
• Michael Kenny, PA
• Laura Lynn Kent-White, APRN
• Stacy Kentrus

• Internal Medicine Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.