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General NPI Number Information
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NPI Number | 1639353121
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Entity Type | Organization
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Legal Business Name | LIVER, KIDNEY AND INTERNAL MEDICINE CENTER
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 509 W TIDWELL RD SUITE 314
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City | HOUSTON
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State | TX
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Zip | 77091-4352
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Country | US
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Telephone | 713-635-6996
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Fax | 713-635-9694
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Provider Business Mailing Address
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Address Line | 509 W TIDWELL RD STE 314
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City | HOUSTON
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State | TX
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Zip | 77091-4354
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Country | US
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Telephone | 713-635-6996
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Fax | 713-635-6994
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN C LIPSEN
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Credential | MD
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Telephone | 713-635-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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