Individual
KENNETH GUSTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6129
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 972-5055
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME38723
FL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
ME38723
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065578300
—
FL
01
—
200001638
RAILROAD MEDICARE
FL
01
—
211378
AVMED
FL
01
—
2314249
CIGNA
FL
01
—
30375
BCBS FLORIDA
FL
01
—
4240449
AETNA
FL
Enumeration date
06/17/2005
Last updated
05/14/2018
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