MEDICARE: LIVER, KIDNEY NAD INTERNAL MEDICINE CENTER

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	261QM1300X	Multi-Specialty Clinic/Center	J8034	TX

General Provider Information

NPI Number	:	1417958067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVER, KIDNEY NAD INTERNAL MEDICINE CENTER

Provider Business Mailing Address
First Line	:	5116 BISSONNET ST
Second Line	:	SUITE 327
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 HOMESTEAD RD
Second Line	:	SUITE 4
City	:	HOUSTON
State	:	TX
Zip	:	77028-2145
Country	:	US
Telephone Number	:	713-635-6996
Fax Number	:	713-635-6994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRYAN C LIPSEN
Credential	:	M.D.
Telephone Number	:	713-635-6996

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/22/2020

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