Provider Demographics
NPI:1376542795
Name:FOLLOWWILL, KENNETH CARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CARL
Last Name:FOLLOWWILL
Suffix:
Gender:M
Credentials:DPM
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 543151
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-3151
Mailing Address - Country:US
Mailing Address - Phone:817-491-4345
Mailing Address - Fax:214-350-2262
Practice Address - Street 1:2800 E HIGHWAY 114 STE 210
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-491-4345
Practice Address - Fax:214-350-2262
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-11-03
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
TX0760213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018810402Medicaid
TXT13294Medicare UPIN
TX018810402Medicaid