MEDICARE: DR. KENNETH ROBERT STEIN M.D.

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	2085R0202X	Diagnostic Radiology Physician	ME39921	FL

General Provider Information

NPI Number	:	1659444057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ROBERT STEIN M.D.

Provider Business Mailing Address
First Line	:	3070 WINDSOR PL
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-5346
Country	:	US
Telephone Number	:	561-452-4100
Fax Number	:	561-893-6853

Provider Business Practice Location Address
First Line	:	1799 W OAKLAND PARK BLVD
Second Line	:	SUITE 105
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1537
Country	:	US
Telephone Number	:	954-777-2427
Fax Number	:	954-777-3510

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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