Individual
KENNETH R KOLLMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
E8638
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130277007
—
TX
05
—
130277008
—
TX
01
—
208087232
CHAMPUS/TRICARE
TX
01
—
8AD480
BLUE CROSS PPO
TX
Enumeration date
09/15/2006
Last updated
07/19/2011
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