Kenick, Matthew M

Kenick, Matthew M is an individual health care provider with primary practice located at 1625 Se 3Rd Avenue Third Floor, Fort Lauderdale FL 33316. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Kenick, Matthew M can be contacted via phone (954) 355-4665.

Contact Information

Primary practice address
1625 Se 3Rd Avenue Third Floor Fort Lauderdale FL 33316
Phone: (954) 355-4665
Fax: (954) 355-4881
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA3593 Florida

Profile Details

NPI number 1922051614
LBN Legal business name Kenick, Matthew M
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Apr 4th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922051614 NPPES
Florida MEDICAID 290516700

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