Provider Demographics
NPI:1871585364
Name:KENT, MICHAEL DALE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DALE
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4017207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173822101Medicaid
TX3833196OtherAETNA HMO
TX173822102Medicaid
TX173822103Medicaid
TX7095249OtherAETNA PPO
TX8G9743OtherBCBS PIN
TX173822104Medicaid
TX173822105Medicaid
TX8G9743OtherBCBS PIN
TX173822102Medicaid
H86230Medicare UPIN
TX8D5386Medicare PIN
TXTXB143727Medicare PIN
TXTXB143729Medicare PIN