MEDICARE: KDS CARDIOVASCULAR SURGERY, PLLC

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1154783710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KDS CARDIOVASCULAR SURGERY, PLLC

Provider Business Mailing Address
First Line	:	118 SHENANDOAH DR
Second Line	:	SUITE A
City	:	SHENANDOAH
State	:	TX
Zip	:	77381-1204
Country	:	US
Telephone Number	:	281-583-4000
Fax Number	:	844-829-3229

Provider Business Practice Location Address
First Line	:	118 SHENANDOAH DR
Second Line	:	SUITE A
City	:	SHENANDOAH
State	:	TX
Zip	:	77381-1204
Country	:	US
Telephone Number	:	281-583-4000
Fax Number	:	844-829-3229

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLIFFORD M KITTEN
Credential	:	M.D.
Telephone Number	:	281-583-4000

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	02/14/2018

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