MEDICARE: DR. MARY KUSUM GEORGE 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	208000000X	Pediatrics Physician	E5084	TX

General Provider Information

NPI Number	:	1285814459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KUSUM GEORGE M.D.

Provider Business Mailing Address
First Line	:	9179 GRISSOM RD STE 135
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-684-1020
Fax Number	:	210-684-2434

Provider Business Practice Location Address
First Line	:	9179 GRISSOM RD STE 135
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-684-1020
Fax Number	:	210-684-2434

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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