MEDICARE: TEXAS KIDZ CLINIC LLC

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	2080A0000X	Pediatric Adolescent Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528325396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS KIDZ CLINIC LLC

Provider Business Mailing Address
First Line	:	800 E DOVE AVE
Second Line	:	SUITE H1
City	:	MCALLEN
State	:	TX
Zip	:	78504-2262
Country	:	US
Telephone Number	:	956-225-2401
Fax Number	:	888-794-8753

Provider Business Practice Location Address
First Line	:	800 E DOVE AVE
Second Line	:	SUITE H1
City	:	MCALLEN
State	:	TX
Zip	:	78504-2262
Country	:	US
Telephone Number	:	956-225-2401
Fax Number	:	888-794-8753

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KESTURKOPPAL MURALIDHARA
Credential	:	MD
Telephone Number	:	956-225-2401

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	03/02/2016

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Directions to “TEXAS KIDZ CLINIC LLC ” Practice Location

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