Individual
KENNETH MICHAEL STEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
535 NW 9TH ST, SUITE 300, OKLAHOMA CITY, OK 73102-1070
(405) 272-6027
(405) 272-8315
Mailing address
535 NW 9TH ST, SUITE 300, OKLAHOMA CITY, OK 73102-1070
(405) 272-6027
(405) 272-8315
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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