MEDICARE: AARON KAMELHAR LSA, CST/CFA

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	363AS0400X	Surgical Physician Assistant	SA00545	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	752613157	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1881759397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON KAMELHAR LSA, CST/CFA

Provider Business Mailing Address
First Line	:	2210 WINSTED DR APT 5108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3887
Country	:	US
Telephone Number	:	214-533-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 WINSTED DR APT 5108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3887
Country	:	US
Telephone Number	:	214-533-8409
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	02/02/2024

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