Provider Demographics
NPI:1629031083
Name:HAAS, KENNETH FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRED
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NE 3RD STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1922
Mailing Address - Country:US
Mailing Address - Phone:863-357-7447
Mailing Address - Fax:863-357-1844
Practice Address - Street 1:115 NE 3RD STREET SUITE C
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1922
Practice Address - Country:US
Practice Address - Phone:863-357-7447
Practice Address - Fax:863-357-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD98895Medicare UPIN
FL46518Medicare ID - Type Unspecified