Provider Demographics
NPI:1154388536
Name:ADAMS, KENNETH K (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:K
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 720999
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-0999
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:817-284-3425
Practice Address - Street 1:1311 W PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1153
Practice Address - Country:US
Practice Address - Phone:214-345-7456
Practice Address - Fax:214-345-4152
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5441208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092464901Medicaid
TX8A9837OtherBCBS
TX8A9837Medicare PIN
TXP00118374Medicare PIN
TX8A9837OtherBCBS