MEDICARE: DR. KELLY MARIE ENGLUND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M6600	TX

General Provider Information

NPI Number	:	1144251406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE ENGLUND MD

Provider Business Mailing Address
First Line	:	21216 NORTHWEST FWY STE 460
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4695
Country	:	US
Telephone Number	:	281-807-5300
Fax Number	:	281-807-5311

Provider Business Practice Location Address
First Line	:	21216 NORTHWEST FWY STE 460
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4695
Country	:	US
Telephone Number	:	281-807-5300
Fax Number	:	281-807-5311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/24/2008

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