Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | H6327 | TX |
NPI | 1295818631 |
---|---|
Provider Name | Dr. Kevin M. Kadesky |
First Address | Dallas, TX 75251-2116 |
Second Address | Dallas, TX 75251-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 08/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1368102-02 | (05) | TX |
F65219 | (02) | TX |