Provider Demographics
NPI:1588664304
Name:FARRELL, KENNETH HAYS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HAYS
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6405 N FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-938-1890
Mailing Address - Fax:954-938-1899
Practice Address - Street 1:6405 N FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-938-1890
Practice Address - Fax:954-938-1899
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19241207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
854168OtherAETNA
1002019OtherUNITED HEALTHCARE
3385753002OtherCIGNA
FL112208OtherCOVENTRY
FLL9PELOtherBCBS
0013293OtherGHI
1000618OtherCAREPLUS
1000618OtherCAREPLUS
3385753002OtherCIGNA
1002019OtherUNITED HEALTHCARE
17921OtherTOTAL HEALTH CARE
1000618OtherCAREPLUS