Provider Demographics
NPI:1457785412
Name:KENNEDY LEGEL, DPM, PLLC
Entity Type:Organization
Organization Name:KENNEDY LEGEL, DPM, PLLC
Other - Org Name:ADVANCED FOOT & ANKLE CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-366-4600
Mailing Address - Street 1:4228 N CENTRAL EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6556
Mailing Address - Country:US
Mailing Address - Phone:214-366-4600
Mailing Address - Fax:214-366-4603
Practice Address - Street 1:4228 N CENTRAL EXPY STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6556
Practice Address - Country:US
Practice Address - Phone:214-366-4600
Practice Address - Fax:214-366-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7087750001Medicare NSC
TX345164Medicare PIN