MEDICARE: CLEMENT A DEFELICE 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	207RC0000X	Cardiovascular Disease Physician	H4899	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060008296	OTHER	TX	RAILROAD MEDICARE

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	:	1710961008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENT A DEFELICE MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 2021
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-790-9125
Fax Number	:	713-790-1802

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	STE 2021
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-790-9125
Fax Number	:	713-790-1802

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	06/26/2008

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Directions to “ CLEMENT A DEFELICE MD” Practice Location

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