# KENNETH A GOLDBERG MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144566985
- **Authorized official:** TONJIA ROAN (OFFICE MANAGER)
- **Authorized official phone:** (972) 420-8500

## Contact information

- **Practice address:** 541 W MAIN ST, SUITE150, LEWISVILLE, TX 75057-3628
- **Practice address phone:** (972) 420-8500
- **Practice address fax:** (972) 221-6302
- **Mailing address:** 541 W MAIN ST, SUITE150, LEWISVILLE, TX 75057-3628
- **Mailing address phone:** (972) 420-8500
- **Mailing address fax:** (972) 221-6302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | F4843 | TX | Yes |

## Other

- **Enumeration date:** 12/26/2012
- **Last updated:** 12/26/2012