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KENNETH MALIQ LOUIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2 TAMPA GENERAL CIR, STC 7TH FLOOR, TAMPA, FL 33606-3603
(813) 259-0904
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME0041511
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
068356600
FL
01
30546
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/21/2006
Last updated
01/03/2019
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