MEDICARE: MR. KENNETH K ADAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	K5441	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154388536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH K ADAMS MD

Provider Business Mailing Address
First Line	:	PO BOX 720999
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75372-0999
Country	:	US
Telephone Number	:	817-284-9850
Fax Number	:	817-284-3425

Provider Business Practice Location Address
First Line	:	1311 W PRESIDENT GEORGE BUSH HWY
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-1153
Country	:	US
Telephone Number	:	214-345-7456
Fax Number	:	214-345-4152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	10/17/2023

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