Provider Demographics
NPI:1588638720
Name:STYSKAL, KENDALL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:WILLIAM
Last Name:STYSKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-1221
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-615-7170
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5907
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-615-7170
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8385207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115966701Medicaid
TX115966707Medicaid
TX8R5128OtherBCBSTX
TX8J9781Medicare PIN