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1467897793

NPI Code Detail

MEDICARE: KELLY A TORNOW MD

MEDICARE: KELLY A TORNOW 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	2085N0700X	Neuroradiology Physician	Q3452	TX
2	390200000X	Student in an Organized Health Care Education/Training Program	02037546	TX
3	2085R0202X	Diagnostic Radiology Physician	Q3452	TX

General Provider Information

NPI Number	:	1467897793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A TORNOW MD

Provider Business Mailing Address
First Line	:	1820 PRESTON PARK BLVD STE 2400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3716
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 PRESTON PARK BLVD STE 2400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3716
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:

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

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	09/26/2022

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Directions to “ KELLY A TORNOW MD” Practice Location

Language	Start Address	Practice Location

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