MEDICARE: DR. KENNETH PODELL PH.D.

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	103G00000X	Clinical Neuropsychologist	36351	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	KP010294	OTHER	COMMERCIAL-COMMERCIAL NUMBER
3	KP010294	OTHER	CHAMPUS-CHAMPUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7509104450	OTHER	BLUE CROSS-BLUE CROSS

General Provider Information

NPI Number	:	1811045404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH PODELL PH.D.

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1840
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2734
Country	:	US
Telephone Number	:	713-441-3780
Fax Number	:	713-790-6468

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 802
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2726
Country	:	US
Telephone Number	:	713-441-3780
Fax Number	:	713-790-6468

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/16/2025

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