Individual
DR. KENNETH K GREENWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
951 PONDELLA RD, COASTAL BEHAVIORAL HEALTHCARE, NORTH FORT MYERS, FL 33903-3532
(239) 656-3461
(239) 656-3462
Mailing address
951 PONDELLA RD, COASTAL BEHAVIORAL HEALTHCARE, NORTH FORT MYERS, FL 33903-3532
(239) 656-3461
(239) 656-3462
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
29687
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100725315 EAST
—
VA
01
—
1013306
CIGNA MCC
—
01
—
107340
UBH HEALTHPLAN
—
01
—
3085173
MAGELLAN PINNACLE
—
01
—
334969
VALUEOPTIONS GROUP
—
01
—
620582605
MENTAL HEALTH NETW
—
01
—
620582605W5
UBH JOHN DEERE
—
Enumeration date
09/12/2006
Last updated
11/02/2016
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