Healthcare Provider Details

I. General information

NPI: 1174722383
Provider Name (Legal Business Name): MEGAN ROSE-LEE WILLIAMS KHMELEV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6496 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

IV. Provider business mailing address

9150 HUEBNER RD STE 160
SAN ANTONIO TX
78240-1545
US

V. Phone/Fax

Practice location:
  • Phone: 210-930-4500
  • Fax:
Mailing address:
  • Phone: 210-960-2639
  • Fax: 210-845-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN1222
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP1-0029850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: