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General NPI Number Information
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NPI Number | 1295807469
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Entity Type | Organization
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Legal Business Name | CENTRAL METROPOLITAN MEDICINE PA
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 1707 CALUMET ST
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City | HOUSTON
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State | TX
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Zip | 77004-7209
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Country | US
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Telephone | 713-523-4420
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Fax | 713-523-4335
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Provider Business Mailing Address
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Address Line | 1707 CALUMET ST
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City | HOUSTON
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State | TX
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Zip | 77004-7209
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Country | US
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Telephone | 713-523-4420
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Fax | 713-523-4335
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ROBIN BOLIVER-CAMPBELL
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Credential | M.D.
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Telephone | 713-523-4420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K1782
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License Number State | TX
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