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General NPI Number Information
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NPI Number | 1780078477
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Entity Type | Organization
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Legal Business Name | KENNETH B SHEPHARD MD PA
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 8700 N KENDALL DR STE 102
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City | MIAMI
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State | FL
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Zip | 33176-2206
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Country | US
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Telephone | 305-273-1919
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Fax | 305-273-1929
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Provider Business Mailing Address
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Address Line | 8700 N KENDALL DR STE 102
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City | MIAMI
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State | FL
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Zip | 33176-2206
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Country | US
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Telephone | 305-273-1919
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Fax | 305-273-1929
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Authorized Official
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Title or Position | ACCT
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Name | MRS. ANN THEISEN
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Credential |
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Telephone | 786-475-3971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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