Provider Demographics
NPI:1447279674
Name:STROUB, KENNETH J (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:STROUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 HERITAGE PASS
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-9117
Mailing Address - Country:US
Mailing Address - Phone:407-635-5956
Mailing Address - Fax:321-841-6974
Practice Address - Street 1:978 HERITAGE PASS
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-9117
Practice Address - Country:US
Practice Address - Phone:407-635-5956
Practice Address - Fax:321-841-6974
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15495207Q00000X
GA043788207Q00000X
FLOS14643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074528Medicaid
GA00758898CMedicaid
NH3074528Medicaid
NH30229268Medicaid