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1326007972

NPI Code Detail

MEDICARE: DR. KENT E. IBANEZ MD

MEDICARE: DR. KENT E. IBANEZ 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	2085R0202X	Diagnostic Radiology Physician	036169257	IL
2	2085R0202X	Diagnostic Radiology Physician	M3269	TX
3	2085N0700X	Neuroradiology Physician	TEMP	TX
4	2085R0202X	Diagnostic Radiology Physician	22674	ND
5	2085R0202X	Diagnostic Radiology Physician	ME170240	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22557	OTHER	NE	NEBRASKA MEDICAL LICENSE
2	P00360851	OTHER		RRMCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	179932201	OTHER	TX	CSHCN2
6	P00360851	OTHER		RRMCARE2
7	179932203	OTHER	TX	CSHCN1

General Provider Information

NPI Number	:	1326007972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT E. IBANEZ MD

Provider Business Mailing Address
First Line	:	12554 RIATA VISTA CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-6431
Country	:	US
Telephone Number	:	512-795-5100
Fax Number	:	512-795-5122

Provider Business Practice Location Address
First Line	:	2160 S 1ST AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-3328
Country	:	US
Telephone Number	:	708-216-9000
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	12/05/2025

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Directions to “ DR. KENT E. IBANEZ MD” Practice Location

Language	Start Address	Practice Location

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