Provider Demographics
NPI:1992771745
Name:LEPAK, KEITH (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:LEPAK
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 1:6501 PRESTON RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2610
Mailing Address - Country:US
Mailing Address - Phone:972-403-1155
Mailing Address - Fax:972-608-0044
Practice Address - Street 1:2700 E ELDORADO PKWY
Practice Address - Street 2:STE 104
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5999
Practice Address - Country:US
Practice Address - Phone:972-987-4935
Practice Address - Fax:972-987-4574
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133591103Medicaid
TXF16307Medicare UPIN
TX85V304Medicare PIN
TX930042386OtherRAILROAD MCARE THRU HEB
TX85V304Medicare PIN