Provider Demographics
NPI:1265400675
Name:STRUBBE, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:STRUBBE
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 1:7100 W 20TH AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1811
Mailing Address - Country:US
Mailing Address - Phone:305-827-5890
Mailing Address - Fax:305-827-5893
Practice Address - Street 1:7100 W 20TH AVE STE 314
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:305-827-5890
Practice Address - Fax:305-827-5893
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254123800Medicaid
FLH09228Medicare UPIN
FL254123800Medicaid