MEDICARE: DR. KIM ELLIOTT MD

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	G7059	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	:	1407954738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM ELLIOTT MD

Provider Business Mailing Address
First Line	:	2300 GREEN OAK DR STE 300
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2051
Country	:	US
Telephone Number	:	281-359-4111
Fax Number	:	281-359-4447

Provider Business Practice Location Address
First Line	:	2300 GREEN OAK DR STE 300
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2051
Country	:	US
Telephone Number	:	281-359-4111
Fax Number	:	281-359-4447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/15/2019

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Directions to “ DR. KIM ELLIOTT MD” Practice Location

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