Provider Demographics
NPI:1972581684
Name:MARGOLIS, KENNETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:MARGOLIS
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 1:9714 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1522
Mailing Address - Country:US
Mailing Address - Phone:832-454-4963
Mailing Address - Fax:
Practice Address - Street 1:9714 CARVER DR
Practice Address - Street 2:
Practice Address - City:IOWA COLONY
Practice Address - State:TX
Practice Address - Zip Code:77583-1522
Practice Address - Country:US
Practice Address - Phone:832-454-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9340207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9901OtherBCBSTX PROV NO
TXP00192816OtherRAILROAD MCARE PROV NO
TX168692501Medicaid
TX168692506Medicaid
TXP00690976Medicare Oscar/Certification
TX8J9901OtherBCBSTX PROV NO
TXP00192816OtherRAILROAD MCARE PROV NO
TX168692501Medicaid