Provider Demographics
NPI:1003371378
Name:KENNETH HENSCHEL, MD, LLC
Entity Type:Organization
Organization Name:KENNETH HENSCHEL, MD, LLC
Other - Org Name:KENNETH HENSCHEL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-901-6288
Mailing Address - Street 1:10123 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3952
Mailing Address - Country:US
Mailing Address - Phone:352-426-5012
Mailing Address - Fax:
Practice Address - Street 1:10123 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3952
Practice Address - Country:US
Practice Address - Phone:352-901-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012860100Medicaid