| Kenneth A. Berdick, M.d., P.a. | |
|
3714 Evans Ave Fort Myers FL 33901-9303 | |
| (239) 334-4157 | |
| (239) 334-1904 |
| Full Name | Kenneth A. Berdick, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3714 Evans Ave, Fort Myers, Florida |
| Authorized Official Name and Position | Kenneth A Berdick (PRESIDENT) |
| Authorized Official Contact | 2393344157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth A. Berdick, M.d., P.a. 3714 Evans Ave Fort Myers FL 33901-9303 Ph: (239) 334-4157 | Kenneth A. Berdick, M.d., P.a. 3714 Evans Ave Fort Myers FL 33901-9303 Ph: (239) 334-4157 |
| NPI Number | 1508125170 |
|---|---|
| Provider Enumeration Date | 05/16/2012 |
| Last Update Date | 09/24/2012 |
| Medicare PECOS PAC ID | 6305093923 |
|---|---|
| Medicare Enrollment ID | O20120904000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508125170 | NPI | - | NPPES |
| 91309 | Other | FL | MEDICARE PTAN |
| 066122800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0017772 (Florida) | Primary |
| 363LP0200X | Nurse Practitioner - Pediatrics | NP1971252 (Florida) | Secondary |
| Provider Name | Kenneth A Berdick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720063993 PECOS PAC ID: 5092772848 Enrollment ID: I20041214000534 |
Tele-id Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14192 Metropolis Ave, Fort Myers, FL 33912 Phone: 239-245-8223 Fax: 239-244-9481 | |
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Lch- Peds Page Field Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4751 S Cleveland Ave, Fort Myers, FL 33907 Phone: 239-343-9888 Fax: 239-343-9968 | |
Lch-internal Medicine Matthew Drive Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1569 Matthew Dr, Fort Myers, FL 33907 Phone: 239-343-8220 Fax: 239-468-7909 | |
G & C Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4048 Evans Ave, Suite 208, Fort Myers, FL 33901 Phone: 786-991-4400 | |
Millennium Physician Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9671 Gladiolus Dr Ste 109, Fort Myers, FL 33908 Phone: 239-362-1450 Fax: 239-985-9629 |