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NPI Code Detail

MEDICARE: DR. MARY ANN KNESEVICH M.D.

MEDICARE:  DR. MARY ANN KNESEVICH  M.D.
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
12084P0800XPsychiatry PhysicianH7770TX

General Provider Information

NPI Number : 1033120811
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ANN KNESEVICH M.D.
Provider Business Mailing Address
First Line : 3508 GENTRY RD
Second Line :
City : IRVING
State : TX
Zip : 75062-4505
Country : US
Telephone Number : 972-541-0261
Fax Number :
Provider Business Practice Location Address
First Line : 4600 SAMUELL BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75228-6827
Country : US
Telephone Number : 214-381-7181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARY ANN KNESEVICH M.D.” Practice Location

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