Provider Demographics
NPI:1902883796
Name:HENSON, KENNETH D (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:HENSON
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 1:3830 BEE RIDGE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1105
Mailing Address - Country:US
Mailing Address - Phone:941-929-1039
Mailing Address - Fax:941-929-1044
Practice Address - Street 1:3830 BEE RIDGE RD
Practice Address - Street 2:STE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1105
Practice Address - Country:US
Practice Address - Phone:941-929-1039
Practice Address - Fax:941-929-1044
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58636207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376150900Medicaid
FL25341OtherBCBS
FL1115887OtherAETNA
FLB30768Medicare UPIN
FL25341BMedicare PIN