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General NPI Number Information
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NPI Number | 1447279674
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Entity Type | Individual
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Provider Name | KENNETH J STROUB D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 05/18/2025
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Provider Practice Location Address
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Address Line | 978 HERITAGE PASS
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City | DAVENPORT
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State | FL
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Zip | 33896-9117
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Country | US
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Telephone | 407-635-5956
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Fax | 321-841-6974
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Provider Business Mailing Address
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Address Line | 978 HERITAGE PASS
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City | DAVENPORT
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State | FL
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Zip | 33896-9117
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Country | US
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Telephone | 407-635-5956
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Fax | 321-841-6974
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15495
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 043788
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS14643
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License Number State | FL
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