MEDICARE: LUDA KAMENETSKY 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	207R00000X	Internal Medicine Physician	K4096	TX

General Provider Information

NPI Number	:	1447235502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUDA KAMENETSKY M.D.

Provider Business Mailing Address
First Line	:	1315 ST JOSEPH PKWY STE 1101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8235
Country	:	US
Telephone Number	:	713-659-3781
Fax Number	:	713-659-6848

Provider Business Practice Location Address
First Line	:	1315 ST JOSEPH PKWY STE 1101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8235
Country	:	US
Telephone Number	:	713-659-3781
Fax Number	:	713-659-6848

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	09/20/2011

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