Provider Demographics
NPI:1265582597
Name:JANEK, KYLE LEE (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LEE
Last Name:JANEK
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:3705 MEDICAL PKWY STE 570
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1024
Practice Address - Country:US
Practice Address - Phone:512-454-2554
Practice Address - Fax:512-454-2824
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84Y565OtherIN HARRIS - MEDICARE
TX125595205Medicaid
TX8016J7OtherOUT HARRIS - MEDICARE
84Y565OtherTX-BLUE SHIELD
TX125595202Medicaid
TX125595207Medicaid
8AW310OtherBLUE CROSS BLUE SHIELD
TX050041689OtherRAILROAD MEDICARE
TX125595205Medicaid
TX050041689OtherRAILROAD MEDICARE
TX440664YK6UMedicare PIN