Provider Demographics
NPI:1821215849
Name:KIPPELS, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:KIPPELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7036 TWIN KNOLL LANE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:214-693-5844
Mailing Address - Fax:972-701-9797
Practice Address - Street 1:14180 DALLAS PKWY
Practice Address - Street 2:SUITE 520
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4341
Practice Address - Country:US
Practice Address - Phone:972-701-9696
Practice Address - Fax:972-701-9797
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5551208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23978Medicare UPIN