Provider Demographics
NPI:1154312585
Name:STEMMLE, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:STEMMLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 PALMER DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8236
Mailing Address - Country:US
Mailing Address - Phone:530-626-2920
Mailing Address - Fax:530-672-7048
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:SUITE 602
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-626-2920
Practice Address - Fax:530-672-7048
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG21257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41224Medicare UPIN