Individual
DR. KENNETH K TIEU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8725 N WICKHAM RD, MELBOURNE, FL 32940-2239
(321) 434-9230
(321) 434-9269
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-9230
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME114362
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117762000
—
FL
01
—
GQ944Y
FL MEDICARE
FL
Enumeration date
04/19/2010
Last updated
12/05/2024
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