Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME38723 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME38723 | FL |
NPI | 1144225855 |
---|---|
Provider Name | Kenneth Gustke |
First Address | Temple Terrace, FL 33637-0925 |
Second Address | Temple Terrace, FL 33637-0925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 14/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065578300 | (05) | FL |
200001638 | RAILROAD MEDICARE (01) | FL |
211378 | AVMED (01) | FL |
2314249 | CIGNA (01) | FL |
30375 | BCBS FLORIDA (01) | FL |
4240449 | AETNA (01) | FL |
D53958 | (02) | FL |