Provider Demographics
NPI:1871748269
Name:KENNETH F HAAS M D P A
Entity type:Organization
Organization Name:KENNETH F HAAS M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:863-357-7447
Mailing Address - Street 1:115 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2901
Mailing Address - Country:US
Mailing Address - Phone:863-357-7447
Mailing Address - Fax:863-357-1844
Practice Address - Street 1:115 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2901
Practice Address - Country:US
Practice Address - Phone:863-357-7447
Practice Address - Fax:863-357-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD98895Medicare UPIN
FL46518Medicare PIN