Thek, Kerry Diane

Thek, Kerry Diane is an individual health care provider with primary practice located at 1690 Dunlawton Ave Ste 120 , Port Orange FL 32127-8980. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Gastroenterology, which is considered as her primary health care specialty. Thek, Kerry Diane can be contacted via phone (386) 677-0531.

Contact Information

Primary practice address
1690 Dunlawton Ave Ste 120 Port Orange FL 32127-8980
Phone: (386) 677-0531
Fax: (386) 673-4658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X E-11212 Arkansas
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X ME58396 Florida

Profile Details

NPI number 1457349417
LBN Legal business name Thek, Kerry Diane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2005
Last updated May 23rd, 2018 - about 8 years 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 1457349417 NPPES
Florida MEDICAID 064841800

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