Provider Demographics
NPI:1154322386
Name:AUSLOOS, KENNETH A (M D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:AUSLOOS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-827-0067
Mailing Address - Fax:214-827-8840
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1808
Practice Address - Country:US
Practice Address - Phone:214-824-8521
Practice Address - Fax:214-827-8840
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2486207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116292701Medicaid
TXE17917Medicare UPIN