=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992934046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KESSEM RESEARCH AND CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2009
-----------------------------------------------------
Last Update Date | 10/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 BEECHNUT ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-727-0011
-----------------------------------------------------
Fax | 281-727-0011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 LEVERKUHN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77007-5744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-727-0011
-----------------------------------------------------
Fax | 281-727-0011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | URI GEDALIA
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 281-727-0011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | N0039
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------