MEDICARE: MARIA CARMEN VISUS MD

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	207R00000X	Internal Medicine Physician	K4602	TX

General Provider Information

NPI Number	:	1366410318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CARMEN VISUS MD

Provider Business Mailing Address
First Line	:	18100 SAINT JOHN DR STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-4601
Country	:	US
Telephone Number	:	281-333-9747
Fax Number	:	281-333-3188

Provider Business Practice Location Address
First Line	:	18100 SAINT JOHN DR
Second Line	:	280
City	:	HOUSTON
State	:	TX
Zip	:	77058-3631
Country	:	US
Telephone Number	:	281-333-9747
Fax Number	:	281-333-3188

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	05/27/2010

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