Healthcare Provider Details

I. General information

NPI: 1225020019
Provider Name (Legal Business Name): ANDRES HUGO KEICHIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 SOUTH LOOP W SUITE 505
HOUSTON TX
77054-1375
US

IV. Provider business mailing address

3003 SOUTH LOOP W SUITE 505
HOUSTON TX
77054-1375
US

V. Phone/Fax

Practice location:
  • Phone: 713-218-9443
  • Fax: 713-218-9447
Mailing address:
  • Phone: 713-218-9443
  • Fax: 713-218-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE3338
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: