KENNETH I LICKER (NPI# 1891781316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891781316 |
| Entity Type | Individual |
| Full Name | KENNETH I LICKER |
| Credential | MD |
| Practice Address |
935 York Dr Desoto TX 75115-2043 |
| Mailing Address |
Po Box 120549 Arlington TX 76012-0549 |
| Practice Telephone | 8177840818 |
| Practice Fax Number | 9727095920 |
| Mailing Telephone | 8173034521 |
| Mailing Fax Number | 9727095920 |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2009-10-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | F7819 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 114910601 | 05 | |
| TX | 114910602 | 05 |
| Street Address |
935 YORK DR |
| City | DESOTO |
| State | TX |
| Zip Code | 75115-2043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649237710 | Tamika L Perry | Family Medicine | 935 York Dr, Desoto, TX 75115-2043 | 2006-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860257 | Emeka Abazie Dds Pa | Dentist | 1001 N. Beckley, Suite 304, Desoto, TX 75115 | 2020-10-30 |
| 1407453384 | Heather Mcdowell | Massage Therapist | 100 Bob White St # 3, Desoto, TX 75115 | 2020-10-05 |
| 1295201580 | Daniel Max & Marcandrea, LLC | Optometrist | 1309 E. Pleasant Run Rd, Desoto, TX 75115 | 2018-10-15 |
| 1316432180 | Texas Home Health Group of De Soto, LLC | Home Health | 911 York Drive, Suite 203, De Soto, TX 75115 | 2018-06-25 |
| 1033606694 | Dental Health Associates of Texas, PC | Dentist | 1001 N Beckley, Desoto, TX 75115 | 2018-04-19 |
| 1023516093 | Joseph Chinaecherem Anya | Pharmacist | 805 Raintree Ln, Desoto, TX 75115 | 2018-01-25 |
| 1396253837 | Medical Care Innovation, P.C. | Clinic/Center | 2019 N Interstate 35 E, Desoto, TX 75115 | 2018-01-18 |
| 1124534888 | Herlonda Dotson | Counselor | 620 Candelila Drive, Desoto, TX 75115 | 2017-12-18 |
| 1053839548 | Floristene Johnson | Nutritionist | 1353 Armstrong Drive, Desoto, TX 75115 | 2017-09-05 |
| 1699290577 | Dlb Pharmacy LLC | Pharmacy | 1801 N Hampton, Suite 340, Desoto, TX 75115 | 2017-08-11 |
| Find all providers in zip 75115 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720018120 | Allan Chad Van Horn | Urology | 2705 Prince George Ave, Desoto, TX 75115-2045 | 2006-07-03 |
| 1093810632 | Siddharth Gulabchand Jain | Urology | 2705 Prince George Ave, Desoto, TX 75115-2045 | 2006-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573765 | William Cooper Buschemeyer IIi, M.d. P.a. | Urology | 26620 Interstate 45-north, The Woodlands, TX 77386 | 2020-09-22 |
| 1619587169 | Jasgurpreet Singh | Urology | 4310 Dunlavy St Apt 350, Houston, TX 77006-5312 | 2020-08-08 |
| 1215443064 | Greater Austin Urology, Pllc | Urology | 11673 Jollyville Rd Ste B101, Austin, TX 78759 | 2017-12-15 |
| 1649780453 | Paul Bradley Md Pllc | Urology | 703 E Marshall Ave Ste 4009, Longview, TX 75601-5500 | 2017-10-06 |
| 1154857977 | Darren M. Chapman M.d., Pllc | Urology | 10970 Shadow Creek Pkwy # 255, Pearland, TX 77584-0100 | 2017-05-11 |
| 1114308467 | Kashyap Shatagopam | Urology | 1900 Scenic Dr Ste 2222, Georgetown, TX 78626-7703 | 2015-06-12 |
| 1114311933 | Marshall Stein | Urology | 7777 Southwest Fwy Ste 540, Houston, TX 77074-1809 | 2015-03-19 |
| 1023401510 | Robert A Bloom Md Pllc | Urology | 416 S. Henderson St., Fort Worth, TX 76104 | 2015-03-09 |
| 1366853152 | Lawrence Tsai | Urology | 12319 N Mopac Expy Ste 200, Austin, TX 78758-2497 | 2014-05-14 |
| 1558780031 | Rachel Sosland | Urology | 4207 James Casey St Ste 107, Austin, TX 78745-1192 | 2014-04-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.