MEDICARE: KENDALL CROWNS

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	207ZF0201X	Forensic Pathology Physician	N2997	TX

General Provider Information

NPI Number	:	1669099917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL CROWNS

Provider Business Mailing Address
First Line	:	PO BOX 1748
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78767-1748
Country	:	US
Telephone Number	:	512-854-9860
Fax Number	:	512-854-9964

Provider Business Practice Location Address
First Line	:	7723 SPRINGDALE RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78724-2200
Country	:	US
Telephone Number	:	512-854-9860
Fax Number	:	512-854-9964

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

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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Directions to “ KENDALL CROWNS ” Practice Location

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