MEDICARE: THOMAS KENJARSKI 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	207L00000X	Anesthesiology Physician	L6458	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CB911	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1770585739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS KENJARSKI MD

Provider Business Mailing Address
First Line	:	4100 INTERNATIONAL PLZ
Second Line	:	STE 600
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4820
Country	:	US
Telephone Number	:	817-529-1923
Fax Number	:	817-877-0350

Provider Business Practice Location Address
First Line	:	2929 AMHERST AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-7806
Country	:	US
Telephone Number	:	214-564-4972
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/27/2011

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