MEDICARE: DR. KENNETH J STROUB D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15495	NH
2	207Q00000X	Family Medicine Physician	043788	GA
3	207Q00000X	Family Medicine Physician	OS14643	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447279674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J STROUB D.O.

Provider Business Mailing Address
First Line	:	978 HERITAGE PASS
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9117
Country	:	US
Telephone Number	:	407-635-5956
Fax Number	:	321-841-6974

Provider Business Practice Location Address
First Line	:	978 HERITAGE PASS
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9117
Country	:	US
Telephone Number	:	407-635-5956
Fax Number	:	321-841-6974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	05/18/2025

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