Provider Demographics
NPI:1154436228
Name:FON SING, MAX KENNY (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:KENNY
Last Name:FON SING
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 1:1291 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6168
Mailing Address - Country:US
Mailing Address - Phone:813-653-1880
Mailing Address - Fax:813-654-2778
Practice Address - Street 1:1291 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33596-6168
Practice Address - Country:US
Practice Address - Phone:813-653-1800
Practice Address - Fax:813-651-0932
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102048207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000984200Medicaid
BF5964247OtherDEA NUMBER
FL0471260001Medicare NSC
FL000984200Medicaid
FLBI004WMedicare PIN
FLBI004ZMedicare Oscar/Certification
FLBI004ZMedicare PIN