Provider Demographics
NPI:1023195112
Name:LEE, KENNETH BARUCH (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BARUCH
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770719
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-0719
Mailing Address - Country:US
Mailing Address - Phone:352-873-4458
Mailing Address - Fax:352-873-8116
Practice Address - Street 1:7860 SW 103RD STREET RD
Practice Address - Street 2:BLDG 100 SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8623
Practice Address - Country:US
Practice Address - Phone:352-873-4458
Practice Address - Fax:352-873-8116
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005913207Q00000X
FL0S0005913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80388OtherBCBS
FLP0021885400OtherRR MEDICARE
FL063885400Medicaid
FL063885400Medicaid
E87656Medicare UPIN