Provider Demographics
NPI:1043460488
Name:STAHL, KENNETH P (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:BOX 016960
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-1288
Mailing Address - Fax:305-585-1020
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:BOX 016960
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1288
Practice Address - Fax:305-585-1020
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2016-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME79521208600000X, 2086S0102X, 2086S0127X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)