MEDICARE: ANGELA MARIE KIRKE RD, LD

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	133V00000X	Registered Dietitian	DT06293	TX

General Provider Information

NPI Number	:	1295176048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE KIRKE RD, LD

Provider Business Mailing Address
First Line	:	1615 HERMANN DR UNIT 1433
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7151
Country	:	US
Telephone Number	:	713-449-9195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 HERMANN DR UNIT 1433
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7151
Country	:	US
Telephone Number	:	713-449-9195
Fax Number	:

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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