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Organization
KENNETH A. BERDICK, M.D., P.A.
Active
Organization
KENNETH A. BERDICK, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH A BERDICK M.D. (PRESIDENT)
(239) 334-4157
Entity
Organization
Contact information
Practice address
3714 EVANS AVE, FORT MYERS, FL 33901-9303
(239) 334-4157
(239) 334-1904
Mailing address
3714 EVANS AVE, FORT MYERS, FL 33901-9303
(239) 334-4157
(239) 334-1904
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0017772
FL
363LP0200X
Pediatric Nurse Practitioner
NP1971252
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066122800
—
FL
01
—
91309
MEDICARE PTAN
FL
Enumeration date
05/16/2012
Last updated
09/24/2012
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