MEDICARE: PROHEALTH MEDICAL GROUP MANAGEMENT

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1952760530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH MEDICAL GROUP MANAGEMENT

Provider Business Mailing Address
First Line	:	8138 S KIRKWOOD RD
Second Line	:	C
City	:	HOUSTON
State	:	TX
Zip	:	77072-3724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 KATY FWY
Second Line	:	101
City	:	HOUSTON
State	:	TX
Zip	:	77024-1944
Country	:	US
Telephone Number	:	832-804-6666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE BUI
Credential	:
Telephone Number	:	720-207-4108

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	02/11/2016

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Directions to “PROHEALTH MEDICAL GROUP MANAGEMENT ” Practice Location

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