Provider Demographics
NPI:1033256805
Name:STEPHENS, W. KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:W. KENNETH
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 O VARSITY WAY
Mailing Address - Street 2:ROOM 335, LINDNER ATHLETIC CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0010
Mailing Address - Country:US
Mailing Address - Phone:513-556-2564
Mailing Address - Fax:513-556-1337
Practice Address - Street 1:2751 O VARSITY WAY
Practice Address - Street 2:ROOM 335, LINDNER ATHLETIC CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-0010
Practice Address - Country:US
Practice Address - Phone:513-556-2564
Practice Address - Fax:513-556-1337
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012555183500000X
OH350381722083S0010X, 2083X0100X, 208D00000X
IN010254572083S0010X, 2083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice