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Individual
KENNETH MICHAEL STEIN
Active
Individual
KENNETH MICHAEL STEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
962
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003580A
—
OK
01
—
432908895002
CUSTOM GROUP SERVICES
—
01
—
731461178005
TRICARE
—
Enumeration date
04/08/2006
Last updated
10/18/2020
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