| Kenneth I Licker, MD | |
|
935 York Dr, Desoto, TX 75115-2043 | |
| (817) 784-0818 | |
| (972) 709-5920 |
| Full Name | Kenneth I Licker |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 935 York Dr, Desoto, Texas |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891781316 | NPI | - | NPPES |
| 114910602 | Medicaid | TX | |
| 114910601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | F7819 (Texas) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth I Licker, MD Po Box 120549, Arlington, TX 76012-0549 Ph: (817) 303-4521 | Kenneth I Licker, MD 935 York Dr, Desoto, TX 75115-2043 Ph: (817) 784-0818 |
Dr. Siddharth Gulabchand Jain, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2705 Prince George Ave, Desoto, TX 75115 Phone: 972-780-0480 Fax: 972-780-1453 | |
Dr. Allan Chad Van Horn, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2705 Prince George Ave, Desoto, TX 75115 Phone: 972-780-0480 Fax: 972-780-1453 | |
Dr. Srinath Kotamarti, Urology Medicare: Accepting Medicare Assignments Practice Location: 2705 Prince George Ave, Desoto, TX 75115 Phone: 972-780-0480 Fax: 972-780-1453 |