Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1891781316 Individual Practitioner Male Practitioner

Dr. Kenneth I Licker , MD

Urology • Desoto, TX

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Licker, MD is a registered healthcare professional specializing in Urology in Desoto, TX. Practice services are available at 935 YORK DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

935 York Dr

Desoto, TX 751152043

Telephone 8177840818
Fax 9727095920
Associated Practice Facility / Clinic
🏢 Elite Women's Wellness Llc Facility NPI 1285414565

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Desoto, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 29.7 Yrs
State Avg: 25.2 Yrs
Regional Practice Density
4 Specialists

Practicing in Desoto, TX (1027 Statewide)

Telehealth Adoption Rate
50.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License TX F7819

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
114910602 (TX)
Medicaid State Provider ID
114910601 (TX)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
NPI 1104961481

CPNPPC

NPI 1568458958

Doctor of Medicine (M.D.)

NPI 1760478150

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active October 09, 2009

NPI status registered as active in NPPES database

📍
Updated Practice Location October 09, 2009

Registered at 935 YORK DR, DESOTO, TX 751152043 (Tel: 8177840818)

📍
Updated Business Mailing Address October 09, 2009

Registered at PO BOX 120549, ARLINGTON, TX 760120549 (Tel: 8173034521)

👤
Provider Name / Credentials Updated October 09, 2009

Recorded as KENNETH LICKER, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 09, 2009

Urology (License #F7819 in TX)

🟢
Initial NPI Registration & Enumeration September 20, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1891781316
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 20, 2005
Last Update: October 09, 2009
Sole Proprietor: No

Mailing Address

Po Box 120549

Arlington, TX 760120549

Phone: 8173034521

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.