Provider Demographics
NPI:1619160603
Name:KIP QUEENAN MD, PLLC
Entity Type:Organization
Organization Name:KIP QUEENAN MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-484-4264
Mailing Address - Street 1:16479 DALLAS PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6825
Mailing Address - Country:US
Mailing Address - Phone:469-484-4264
Mailing Address - Fax:
Practice Address - Street 1:16479 DALLAS PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6825
Practice Address - Country:US
Practice Address - Phone:469-484-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty