MEDICARE: KEITH LEPAK 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	207P00000X	Emergency Medicine Physician	H9670	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992771745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH LEPAK MD

Provider Business Mailing Address
First Line	:	6501 PRESTON RD
Second Line	:	STE 102
City	:	PLANO
State	:	TX
Zip	:	75024-2610
Country	:	US
Telephone Number	:	972-403-1155
Fax Number	:	972-608-0044

Provider Business Practice Location Address
First Line	:	2700 E ELDORADO PKWY
Second Line	:	STE 104
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5999
Country	:	US
Telephone Number	:	972-987-4935
Fax Number	:	972-987-4574

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/23/2015

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Directions to “ KEITH LEPAK MD” Practice Location

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