Provider Demographics
NPI:1851468045
Name:HORAK, KENNETH R (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:HORAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1401
Mailing Address - Country:US
Mailing Address - Phone:972-896-2693
Mailing Address - Fax:
Practice Address - Street 1:1809 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1401
Practice Address - Country:US
Practice Address - Phone:972-896-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDOH2468207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F24711Medicare UPIN