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NPI Code Detail

MEDICARE: DR. KENNETH G. LOMENZO M.D.

MEDICARE: DR. KENNETH G. LOMENZO M.D.
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
1207Q00000XFamily Medicine PhysicianL2429TX

General Provider Information

NPI Number : 1861442642
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH G. LOMENZO M.D.
Provider Business Mailing Address
First Line : 6100 CALDWELL ST
Second Line :
City : WACO
State : TX
Zip : 76710-2624
Country : US
Telephone Number : 254-751-0093
Fax Number :
Provider Business Practice Location Address
First Line : 701 MCCLINTIC DR
Second Line :
City : GROESBECK
State : TX
Zip : 76642-2128
Country : US
Telephone Number : 254-729-3411
Fax Number : 254-729-3258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 03/14/2013

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