Provider Demographics
NPI:1902872781
Name:FEUER, KENNETH RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RUSSELL
Last Name:FEUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-9585
Practice Address - Street 1:9430 TURKEY LAKE RD
Practice Address - Street 2:STE 206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-9585
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46704207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0624419OtherAETNA
FL061541200Medicaid
FL47753OtherBC/BS
FL2900080OtherUNITED HEALTHCARE
FL47753XMedicare ID - Type Unspecified
FLD62569Medicare UPIN
FL2900080OtherUNITED HEALTHCARE