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General NPI Number Information
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NPI Number | 1053518589
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Entity Type | Individual
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Provider Name | AIMEE GRETCHEN KAKASCIK D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 6621 FANNIN ST STE 310 MC 2-1495
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City | HOUSTON
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State | TX
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Zip | 77030-2303
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Country | US
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Telephone | 832-824-5900
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Fax | 832-825-5905
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Provider Business Mailing Address
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Address Line | 6621 FANNIN ST STE 310 MC 2-1495
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City | HOUSTON
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State | TX
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Zip | 77030-2303
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Country | US
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Telephone | 832-824-5900
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Fax | 832-825-5905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | M9392
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 19731
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License Number State | MS
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