| Kenneth Wilson Backstrand, MD | |
| 2721 Del Prado Blvd S, Cape Coral, FL 33904-5781 | |
| (239) 242-8010 | |
| (239) 242-8020 | 
| Full Name | Kenneth Wilson Backstrand | 
|---|---|
| Gender | Male | 
| Speciality | Anesthesiology - Pain Medicine | 
| Location | 2721 Del Prado Blvd S, Cape Coral, Florida | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1114915477 | NPI | - | NPPES | 
| 046206300 | Medicaid | FL | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207L00000X | Anesthesiology | ME0050622 (Florida) | Secondary | 
| 207LP2900X | Anesthesiology - Pain Medicine | ME50622 (Florida) | Primary | 
| Entity Name | Moonlight Anesthesia, P.l. | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1033419791 PECOS PAC ID: 0547442758 Enrollment ID: O20110309000707 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kenneth Wilson Backstrand, MD 40 Barkley Cir Ste 3, Fort Myers, FL 33907-4518 Ph: (239) 226-0910 | Kenneth Wilson Backstrand, MD 2721 Del Prado Blvd S, Cape Coral, FL 33904-5781 Ph: (239) 242-8010 | 
| Dr. John T Patrick, MD, ANESTESIOLOGIST Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 4120 Del Prado Blvd S, Cape Coral, FL 33904 Phone: 239-542-2020 Fax: 239-541-1492 | |
| William Michael Johnson, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 523 Cape Coral Pkwy E, Cape Coral, FL 33904 Phone: 239-549-2772 Fax: 239-549-2332 | |
| Dr. Jules Alva Preudhomme, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1228 Se 8th Ter, Cape Coral, FL 33990 Phone: 239-945-1105 Fax: 239-945-4495 | |
| Remone Tharwat Yousif, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 650 Del Prado Blvd S Ste 106, Cape Coral, FL 33990 Phone: 239-424-3492 Fax: 239-424-4030 |