Healthcare Provider Details

I. General information

NPI: 1033256805
Provider Name (Legal Business Name): W. KENNETH STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 O VARSITY WAY ROOM 335, LINDNER ATHLETIC CENTER
CINCINNATI OH
45221-0010
US

IV. Provider business mailing address

2751 O VARSITY WAY ROOM 335, LINDNER ATHLETIC CENTER
CINCINNATI OH
45221-0010
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-2564
  • Fax: 513-556-1337
Mailing address:
  • Phone: 513-556-2564
  • Fax: 513-556-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26012555
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number35038172
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number01025457
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35038172
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01025457
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35038172
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01025457
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: