MEDICARE: DR. SHELBY DANIELLE KILES M.D.

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	207Q00000X	Family Medicine Physician	P9383	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P9383	OTHER	TX	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1265793426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELBY DANIELLE KILES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5598 NORTH FWY # A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4702
Country	:	US
Telephone Number	:	832-548-5000
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	02/15/2018

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