MEDICARE: KIP QUEENAN MD, PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1619160603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIP QUEENAN MD, PLLC

Provider Business Mailing Address
First Line	:	16479 DALLAS PKWY
Second Line	:	SUITE 320
City	:	ADDISON
State	:	TX
Zip	:	75001-6825
Country	:	US
Telephone Number	:	469-484-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	16479 DALLAS PKWY
Second Line	:	SUITE 320
City	:	ADDISON
State	:	TX
Zip	:	75001-6825
Country	:	US
Telephone Number	:	469-484-4264
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KIP E. QUEENAN
Credential	:	M.D.
Telephone Number	:	469-484-4264

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	06/26/2013

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