MEDICARE: MS. MARILYN KATHERINE KUEHN

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	363AS0400X	Surgical Physician Assistant
2	363AS0400X	Surgical Physician Assistant	CERT.#112610	TX

General Provider Information

NPI Number	:	1184941262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN KATHERINE KUEHN

Provider Business Mailing Address
First Line	:	PO BOX 542333
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254
Country	:	US
Telephone Number	:	713-299-7677
Fax Number	:	281-768-6766

Provider Business Practice Location Address
First Line	:	804 CIRCLE DR.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77401
Country	:	US
Telephone Number	:	713-299-7677
Fax Number	:	281-768-6766

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/06/2012

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