MEDICARE: BRAINFLO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	L5412	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L5412	OTHER	TX	LICENSE /PERMIT #

General Provider Information

NPI Number	:	1013150507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINFLO PA

Provider Business Mailing Address
First Line	:	PO BOX 004814
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-0001
Country	:	US
Telephone Number	:	281-466-1891
Fax Number	:	281-296-9044

Provider Business Practice Location Address
First Line	:	2180 NORTH LOOP W
Second Line	:	STE 320
City	:	HOUSTON
State	:	TX
Zip	:	77018-8014
Country	:	US
Telephone Number	:	832-384-1560
Fax Number	:	832-384-1585

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	HAESUE FLORENCE KIM
Credential	:	M.D.
Telephone Number	:	281-466-1891

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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Directions to “BRAINFLO PA ” Practice Location

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