Provider Demographics
NPI:1043270630
Name:BRENSKI, AMY CORNELIA (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CORNELIA
Last Name:BRENSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:11445 DALLAS PKWY STE 240
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4254
Practice Address - Country:US
Practice Address - Phone:214-494-4150
Practice Address - Fax:972-315-9053
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0049207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105828101Medicaid
TX105828105Medicaid
TX8871K1Medicare ID - Type Unspecified