MEDICARE: CENTRAL METROPOLITAN MEDICINE 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	207R00000X	Internal Medicine Physician	K1782	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295807469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL METROPOLITAN MEDICINE PA

Provider Business Mailing Address
First Line	:	1707 CALUMET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7209
Country	:	US
Telephone Number	:	713-523-4420
Fax Number	:	713-523-4335

Provider Business Practice Location Address
First Line	:	1707 CALUMET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7209
Country	:	US
Telephone Number	:	713-523-4420
Fax Number	:	713-523-4335

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	ROBIN BOLIVER-CAMPBELL
Credential	:	M.D.
Telephone Number	:	713-523-4420

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	10/29/2007

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Directions to “CENTRAL METROPOLITAN MEDICINE PA ” Practice Location

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