Individual
KENNETH R KOLLMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 W COLORADO BLVD, SUITE 625, DALLAS, TX 75208-2363
(214) 946-5165
Mailing address
221 W COLORADO BLVD, SUITE 625, DALLAS, TX 75208-2363
(214) 946-5165
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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