MEDICARE: KETE HEALTH CENTER LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1649562430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KETE HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	3730 FM 1960 RD W
Second Line	:	SUITE 108
City	:	HOUSTON
State	:	TX
Zip	:	77068-3530
Country	:	US
Telephone Number	:	281-627-4919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 FM 1960 RD W
Second Line	:	SUITE 108
City	:	HOUSTON
State	:	TX
Zip	:	77068-3530
Country	:	US
Telephone Number	:	281-627-4919
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. OLZHAS KETEBAYEV
Credential	:
Telephone Number	:	281-627-4919

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	05/11/2011

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