Healthcare Provider Details

I. General information

NPI: 1164493870
Provider Name (Legal Business Name): KALYANAM SUBRAMANYAM VI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MED CENTER BLVD # 1300
WEBSTER TX
77598-4055
US

IV. Provider business mailing address

1015 MED CENTER BLVD # 1300
WEBSTER TX
77598-4055
US

V. Phone/Fax

Practice location:
  • Phone: 281-557-2527
  • Fax: 281-557-7203
Mailing address:
  • Phone: 281-557-2527
  • Fax: 281-557-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberF9035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: