Provider Demographics
NPI:1558500801
Name:LEGEL, KENNEDY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:
Last Name:LEGEL
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 1:4228 N CENTRAL EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6556
Mailing Address - Country:US
Mailing Address - Phone:214-366-4600
Mailing Address - Fax:214-366-4603
Practice Address - Street 1:4228 N CENTRAL EXPY STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6556
Practice Address - Country:US
Practice Address - Phone:214-366-4600
Practice Address - Fax:214-366-4603
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP03358213ES0103X
TX1911213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1911OtherTX STATE LIC