MEDICARE: KMC CLINIC WILCREST

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1124731674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMC CLINIC WILCREST

Provider Business Mailing Address
First Line	:	11658 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	281-302-5121
Fax Number	:	281-302-6294

Provider Business Practice Location Address
First Line	:	11658 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	281-302-5121
Fax Number	:	281-302-6294

Authorized Official
Title or Position	:	AUTHRORIZED OFFICIAL
Name	:	REGGIE ABRAHAM
Credential	:
Telephone Number	:	281-398-7778

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	08/04/2023

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Directions to “KMC CLINIC WILCREST ” Practice Location

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