Healthcare Provider Details

I. General information

NPI: 1316056468
Provider Name (Legal Business Name): MADHURI VINAYAKRAO KAMBLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 TAUB LOOP NEURO PSYCHIATRIC CENTER
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

9401 SOUTHWEST FWY
HOUSTON TX
77074-1407
US

V. Phone/Fax

Practice location:
  • Phone: 713-970-4640
  • Fax: 713-970-4744
Mailing address:
  • Phone: 713-970-7687
  • Fax: 713-970-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK9578
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberK9578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: