Provider Demographics
NPI:1649387713
Name:KAHLENBERG, MORTON S (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:S
Last Name:KAHLENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5403
Mailing Address - Country:US
Mailing Address - Phone:210-946-1400
Mailing Address - Fax:210-946-1010
Practice Address - Street 1:8711 VILLAGE DR STE 325
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5403
Practice Address - Country:US
Practice Address - Phone:210-946-1400
Practice Address - Fax:210-946-1010
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL03062086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043858201Medicaid