Provider Demographics
NPI:1568411262
Name:SHEPHARD, KENNETH B (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:SHEPHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8501 SW 124TH AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4633
Mailing Address - Country:US
Mailing Address - Phone:305-273-1919
Mailing Address - Fax:305-272-1925
Practice Address - Street 1:8501 SW 124TH AVE
Practice Address - Street 2:STE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4633
Practice Address - Country:US
Practice Address - Phone:305-273-1919
Practice Address - Fax:305-273-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME61784207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG19282Medicare UPIN
FL27860AMedicare ID - Type Unspecified