Healthcare Provider Details

I. General information

NPI: 1457785412
Provider Name (Legal Business Name): KENNEDY LEGEL, DPM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 N CENTRAL EXPY STE 210
DALLAS TX
75206-6556
US

IV. Provider business mailing address

4228 N CENTRAL EXPY STE 210
DALLAS TX
75206-6556
US

V. Phone/Fax

Practice location:
  • Phone: 214-366-4600
  • Fax: 214-366-4603
Mailing address:
  • Phone: 214-366-4600
  • Fax: 214-366-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNEDY LEGEL
Title or Position: OWNER
Credential: DPM
Phone: 214-366-4600