KENNETH I LICKER MD NPI 1891781316

NPI Information

NPI: 1891781316
Provider Name: KENNETH I LICKER, MD
Classification: Urology - 208800000X
Entity Type: Individual
Address:
935 YORK DR
DESOTO, TX
ZIP 75115
Phone: (817) 784-0818
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Kenneth I Licker, MD is an urology in Desoto, TX. The provider is 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. Kenneth I Licker, MD NPI is 1891781316. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

935 YORK DR
DESOTO, TX
ZIP 75115-043
Phone: (817) 784-0818
Fax: (972) 709-5920

The enumeration date for this NPI number is 9/20/2005 and was last updated on 10/9/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208800000X	Urology		F7819	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	114910601	MEDICAID	TEXAS
2	114910602	MEDICAID	TEXAS
3	8036J2	MEDICARE PIN	TEXAS
4	83Z808	MEDICARE PIN	TEXAS
5	B24376	MEDICARE UPIN	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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