Provider Demographics
NPI:1083809255
Name:SHAIN, KENNETH H (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:SHAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MRC 3RD FLOOR EAST
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-4748
Mailing Address - Fax:813-745-6817
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MRC 3RD FLOOR EAST
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-4748
Practice Address - Fax:813-745-6817
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-08-26
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Provider Licenses
StateLicense IDTaxonomies
FLME107261207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology