Provider Demographics
NPI:1982641361
Name:KREKOW, LEA KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:KATHLEEN
Last Name:KREKOW
Suffix:
Gender:F
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-359-9000
Practice Address - Fax:817-359-9062
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0166207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8R1491OtherBLUE CROSS OF TX
TX8086M0Medicare PIN
TX89Y831Medicare PIN
TN8R1491OtherBLUE CROSS OF TX
TX87711KMedicare PIN