MEDICARE: DR. KENNETH E STANLEY MD

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	208800000X	Urology Physician	057809	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340008614	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000027893	OTHER		ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518984137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH E STANLEY MD

Provider Business Mailing Address
First Line	:	1220 E ELM ST STE 101
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2803
Country	:	US
Telephone Number	:	419-228-0570
Fax Number	:	419-228-0943

Provider Business Practice Location Address
First Line	:	1220 E ELM ST STE 101
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2803
Country	:	US
Telephone Number	:	419-228-0570
Fax Number	:	419-228-0943

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/13/2008

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Directions to “ DR. KENNETH E STANLEY MD” Practice Location

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