Provider Demographics
NPI:1841667524
Name:HOMANN, KENNETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:HOMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:832-522-8104
Mailing Address - Fax:
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:832-522-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMP10252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist