Healthcare Provider Details

I. General information

NPI: 1003307372
Provider Name (Legal Business Name): KEVANIC ROSSLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date: 11/22/2025
Reactivation Date: 07/02/2026

III. Provider practice location address

3606 ELSBERRY PARK LN
KATY TX
77450-8057
US

IV. Provider business mailing address

3606 ELSBERRY PARK LN
KATY TX
77450-8057
US

V. Phone/Fax

Practice location:
  • Phone: 832-938-5847
  • Fax:
Mailing address:
  • Phone: 832-938-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberTT-26-13
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: