Provider Demographics
NPI:1144389099
Name:SCHRUNK, KEVIN F (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:F
Last Name:SCHRUNK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3938
Mailing Address - Country:US
Mailing Address - Phone:214-821-9161
Mailing Address - Fax:214-824-1039
Practice Address - Street 1:6331 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3938
Practice Address - Country:US
Practice Address - Phone:214-821-9161
Practice Address - Fax:214-824-1039
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244812707Medicaid
TX329242YKY6Medicare PIN
MO244812707Medicaid
MOF83045Medicare UPIN